Provider Demographics
NPI:1598400186
Name:VIAL DENTISTRY PROF CORP
Entity Type:Organization
Organization Name:VIAL DENTISTRY PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:VIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-560-3067
Mailing Address - Street 1:2717 DOME CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-4062
Mailing Address - Country:US
Mailing Address - Phone:775-560-3067
Mailing Address - Fax:
Practice Address - Street 1:15 MCCABE DR STE 202
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4816
Practice Address - Country:US
Practice Address - Phone:775-284-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental