# DESERT VALLEY DENTAL OF LAKESIDE CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Desert Valley Dental of Lakeside Corp
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083190078
- **Authorized official:** ROBYN GOODMAN DDS (OWNER)
- **Authorized official phone:** (775) 825-1055

## Contact information

- **Practice address:** 3665 LAKESIDE DR, RENO, NV 89509-5280
- **Practice address phone:** (775) 825-1055
- **Practice address fax:** (775) 825-1084
- **Mailing address:** 3665 LAKESIDE DR, RENO, NV 89509-5280
- **Mailing address phone:** (775) 825-1055
- **Mailing address fax:** (775) 825-1084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4858 | NV | Yes |

## Other

- **Enumeration date:** 07/13/2018
- **Last updated:** 07/13/2018