Provider Demographics
NPI:1528598679
Name:THE DENTISTS' OFFICE FERNLEY LLC
Entity Type:Organization
Organization Name:THE DENTISTS' OFFICE FERNLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-336-1510
Mailing Address - Street 1:3605 GRANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-336-1510
Mailing Address - Fax:775-823-5218
Practice Address - Street 1:90 FALCON DR STE 110
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-4729
Practice Address - Country:US
Practice Address - Phone:775-336-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1223P0221XOtherGENERAL DENTISTRY