Organization
SUMMIT BOULEVARD DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ADAMS DMD (OWNER)
(615) 601-4728
Entity
Organization
Contact information
Practice address
13985 S VIRGINIA ST STE 806, RENO, NV 89511-8934
(775) 846-4777
(775) 525-5512
Mailing address
13985 S VIRGINIA ST STE 806, RENO, NV 89511-8934
(775) 846-4777
(775) 525-5512
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
S7-88C
NV
1223E0200X
Endodontics
S7-881
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306026679
DENTISTRY
—
Enumeration date
04/30/2018
Last updated
04/30/2018
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