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3665 Lakeside Dr Reno NV 89509-5280 | |
| (775) 825-1055 | |
| (775) 825-1084 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3665 Lakeside Dr, Reno, Nevada |
| Authorized Official Name and Position | Robyn Goodman (OWNER) |
| Authorized Official Contact | 7758251055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3665 Lakeside Dr Reno NV 89509-5280 Ph: (775) 825-1055 | 3665 Lakeside Dr Reno NV 89509-5280 Ph: (775) 825-1055 |
| NPI Number | 1083190078 |
|---|---|
| Provider Enumeration Date | 07/13/2018 |
| Last Update Date | 07/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083190078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4858 (Nevada) | Primary |
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