Provider Demographics
NPI:1508038860
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:SAINT MARY'S WIC DENTAL PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAKYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-6239
Mailing Address - Street 1:5250 NEIL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6555
Mailing Address - Country:US
Mailing Address - Phone:775-770-3558
Mailing Address - Fax:775-770-6110
Practice Address - Street 1:1510 MEADOW WOOD LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8503
Practice Address - Country:US
Practice Address - Phone:775-770-3456
Practice Address - Fax:775-770-6110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
880059665OtherIRS - SP TIN