Organization
PONDEROSA FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALETA BEUTER (CREDENTIALING SPECIALIST)
(775) 409-4614
Entity
Organization
Contact information
Practice address
307 W WINNIE LN STE 2, CARSON CITY, NV 89703-2145
(775) 885-2323
Mailing address
3605 GRANT DR, RENO, NV 89509-5301
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000
NO OTHER
—
Enumeration date
09/30/2021
Last updated
09/30/2021
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