Provider Demographics
NPI:1326391301
Name:KWONG DENTAL CARE
Entity Type:Organization
Organization Name:KWONG DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-323-3892
Mailing Address - Street 1:333 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-323-3892
Mailing Address - Fax:775-323-4441
Practice Address - Street 1:333 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1645
Practice Address - Country:US
Practice Address - Phone:775-323-3892
Practice Address - Fax:775-323-4441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KWONG DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5686305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization