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5420 Kietzke Ln Ste 102 Reno NV 89511-2063 | |
| (775) 853-9696 | |
| (775) 853-9695 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 5420 Kietzke Ln Ste 102, Reno, Nevada |
| Authorized Official Name and Position | Rick J Rawson (OWNER) |
| Authorized Official Contact | 7758539696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5420 Kietzke Ln Ste 102 Reno NV 89511-2063 Ph: (775) 853-9696 | 5420 Kietzke Ln Ste 102 Reno NV 89511-2063 Ph: (775) 853-9696 |
| NPI Number | 1750637096 |
|---|---|
| Provider Enumeration Date | 07/24/2012 |
| Last Update Date | 07/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750637096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | S295C (Nevada) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 6268 (Nevada) | Secondary |
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