| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3645 Warren Way, Reno, Nevada |
| Authorized Official Name and Position | Jason Champagne (OWNER) |
| Authorized Official Contact | 7754623111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2070 Sparks NV 89432-2070 Ph: () - | 3645 Warren Way Reno NV 89509-5241 Ph: (775) 462-3111 |
| NPI Number | 1841021045 |
|---|---|
| Provider Enumeration Date | 08/09/2024 |
| Last Update Date | 11/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841021045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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