# SUMMIT BOULEVARD DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063900595
- **Authorized official:** DR. TIMOTHY ADAMS DMD (OWNER)
- **Authorized official phone:** (615) 601-4728

## Contact information

- **Practice address:** 13985 S VIRGINIA ST STE 806, RENO, NV 89511-8934
- **Practice address phone:** (775) 846-4777
- **Practice address fax:** (775) 525-5512
- **Mailing address:** 13985 S VIRGINIA ST STE 806, RENO, NV 89511-8934
- **Mailing address phone:** (775) 846-4777
- **Mailing address fax:** (775) 525-5512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | S7-88C | NV | Yes |
| 1223E0200X | Endodontics | S7-881 | NV | — |

## Other

- **Enumeration date:** 04/30/2018
- **Last updated:** 04/30/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1306026679 | DENTISTRY | — |