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Organization

SPARKS FAMILY DENTISTRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS AJ BASORA DDS (MANAGER)
(775) 359-3337
Entity
Organization

Contact information

Practice address
340 PYRAMID WAY, SPARKS, NV 89431
(775) 359-3336
(775) 359-0755
Mailing address
340 PYRAMID WAY, SPARKS, NV 89431
(775) 359-3336
(775) 359-0755

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4481
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4481
LIC #
NV
Enumeration date
03/20/2007
Last updated
08/22/2020
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