Provider Demographics
NPI:1619591906
Name:DESERT VALLEY DENTAL DAMONTE INC
Entity Type:Organization
Organization Name:DESERT VALLEY DENTAL DAMONTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-971-3971
Mailing Address - Street 1:5990 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2303
Mailing Address - Country:US
Mailing Address - Phone:775-971-3971
Mailing Address - Fax:775-971-3973
Practice Address - Street 1:1101 STEAMBOAT PKWY STE 310
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6078
Practice Address - Country:US
Practice Address - Phone:775-971-3971
Practice Address - Fax:775-971-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty