Provider Demographics
NPI:1518355395
Name:KID DENTAL LLC
Entity Type:Organization
Organization Name:KID DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-825-5005
Mailing Address - Street 1:1301 N MCCARRAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3870
Mailing Address - Country:US
Mailing Address - Phone:775-825-5005
Mailing Address - Fax:775-624-8188
Practice Address - Street 1:1301 N MCCARRAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3870
Practice Address - Country:US
Practice Address - Phone:775-825-5005
Practice Address - Fax:775-624-8188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KID DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty