Provider Demographics
NPI:1164295325
Name:RENO DENTAL PARTNERS, LLC
Entity Type:Organization
Organization Name:RENO DENTAL PARTNERS, LLC
Other - Org Name:BOCA DENTAL AND BRACES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-1929
Mailing Address - Street 1:8989 W FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-0431
Mailing Address - Country:US
Mailing Address - Phone:702-522-1929
Mailing Address - Fax:702-475-6504
Practice Address - Street 1:568 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5278
Practice Address - Country:US
Practice Address - Phone:775-237-2267
Practice Address - Fax:775-237-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty