Organization
NORTHERN NEVADA DENTAL SPECIALTY GROUP
Active
Other names
My Kid's Smile
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS CHANNING CHRISTIANSEN (MANAGER)
(775) 848-3005
Entity
Organization
Contact information
Practice address
3150 VISTA BLVD, SUITE 110, SPARKS, NV 89436-6712
(775) 852-6164
Mailing address
10645 DOUBLE R BLVD, RENO, NV 89521-8920
(775) 852-6164
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4489
NV
1223P0221X
Pediatric Dentistry
36-117
NV
Other
Enumeration date
06/24/2015
Last updated
06/24/2015
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