Provider Demographics
NPI:1750637096
Name:RENO ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:RENO ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:RICK J. RAWSON, D.D.S., M.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:775-853-9696
Mailing Address - Street 1:5420 KIETZKE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2063
Mailing Address - Country:US
Mailing Address - Phone:775-853-9696
Mailing Address - Fax:775-853-9695
Practice Address - Street 1:5420 KIETZKE LN STE 102
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2063
Practice Address - Country:US
Practice Address - Phone:775-853-9696
Practice Address - Fax:775-853-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS295C1223S0112X
NV62681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty