Provider Demographics
NPI:1417356452
Name:JOSHUA BRANCO DMD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOSHUA BRANCO DMD A PROFESSIONAL CORPORATION
Other - Org Name:SAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-843-2297
Mailing Address - Street 1:1080 N HILLS BLVD # 150
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-6744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1080 N HILLS BLVD # 150
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-6744
Practice Address - Country:US
Practice Address - Phone:775-843-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV59551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty