Provider Demographics
NPI:1083780647
Name:PENDLETON, ERIC BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRUCE
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MOANA LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W MOANA LN
Practice Address - Street 2:SUITE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4955
Practice Address - Country:US
Practice Address - Phone:775-825-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice