Provider Demographics
NPI:1639306517
Name:JUST SMILES DENTAL CARE, MCGRUDER P.C.
Entity Type:Organization
Organization Name:JUST SMILES DENTAL CARE, MCGRUDER P.C.
Other - Org Name:JUST SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-671-8659
Mailing Address - Street 1:2900 CLEAR ACRE LN
Mailing Address - Street 2:SUITE S
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1712
Mailing Address - Country:US
Mailing Address - Phone:775-337-6453
Mailing Address - Fax:775-337-2854
Practice Address - Street 1:2900 CLEAR ACRE LN
Practice Address - Street 2:SUITE S
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1712
Practice Address - Country:US
Practice Address - Phone:775-337-6453
Practice Address - Fax:775-337-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5870261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental