Provider Demographics
NPI:1053450288
Name:DR. GARY DANCHAK, OMD
Entity Type:Organization
Organization Name:DR. GARY DANCHAK, OMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-849-9800
Mailing Address - Street 1:9393 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8910
Mailing Address - Country:US
Mailing Address - Phone:775-849-9800
Mailing Address - Fax:775-849-9801
Practice Address - Street 1:9393 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8910
Practice Address - Country:US
Practice Address - Phone:775-849-9800
Practice Address - Fax:775-849-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1010261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center