Provider Demographics
NPI:1134701733
Name:KID DENTAL HOSPITAL PROGRAM LLC
Entity Type:Organization
Organization Name:KID DENTAL HOSPITAL PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-420-4400
Mailing Address - Street 1:1101 W MOANA LN STE 14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4734
Mailing Address - Country:US
Mailing Address - Phone:775-420-4400
Mailing Address - Fax:775-420-4776
Practice Address - Street 1:3645 WARREN WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5241
Practice Address - Country:US
Practice Address - Phone:775-825-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4833OtherNEVADA DENTAL BOARD