Provider Demographics
NPI:1427220037
Name:NORTHERN NEVADA DENTAL HEALTH PROGRAMS
Entity Type:Organization
Organization Name:NORTHERN NEVADA DENTAL HEALTH PROGRAMS
Other - Org Name:HEALTHY SMILE HEALTHY CHILD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PISANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-337-0296
Mailing Address - Street 1:5605 RIGGINS CT STE 101A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6575
Mailing Address - Country:US
Mailing Address - Phone:775-982-7989
Mailing Address - Fax:775-337-0298
Practice Address - Street 1:5605 RIGGINS CT STE 101A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6575
Practice Address - Country:US
Practice Address - Phone:775-982-7989
Practice Address - Fax:775-337-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002216200Medicaid
NV002216008Medicaid
NV002216200Medicaid