# NORTHERN NEVADA DENTAL SPECIALTY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** My Kid's Smile
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073995213
- **Authorized official:** MR. NICHOLAS CHANNING CHRISTIANSEN (MANAGER)
- **Authorized official phone:** (775) 848-3005

## Contact information

- **Practice address:** 3150 VISTA BLVD, SUITE 110, SPARKS, NV 89436-6712
- **Practice address phone:** (775) 852-6164
- **Mailing address:** 10645 DOUBLE R BLVD, RENO, NV 89521-8920
- **Mailing address phone:** (775) 852-6164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4489 | NV | Yes |
| 1223P0221X | Pediatric Dentistry | 36-117 | NV | — |

## Other

- **Enumeration date:** 06/24/2015
- **Last updated:** 06/24/2015