Provider Demographics
NPI:1699367110
Name:INNOVATIVE DENTAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE DENTAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DESIPIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-588-5183
Mailing Address - Street 1:PO BOX 10408
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2408
Mailing Address - Country:US
Mailing Address - Phone:775-588-5183
Mailing Address - Fax:775-364-1744
Practice Address - Street 1:120 MCFAUL WAY
Practice Address - Street 2:
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448-9807
Practice Address - Country:US
Practice Address - Phone:775-588-5183
Practice Address - Fax:775-364-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental