Provider Demographics
NPI:1164577003
Name:ERIC B. PENDLETON, D.D.S., LTD.
Entity Type:Organization
Organization Name:ERIC B. PENDLETON, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-825-5711
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:775-825-5711
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty