Provider Demographics
NPI:1790808004
Name:KAMINSKI, JOHN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 BEDFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4616
Mailing Address - Country:US
Mailing Address - Phone:775-882-8657
Mailing Address - Fax:
Practice Address - Street 1:1155 W 4TH ST STE 218
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5149
Practice Address - Country:US
Practice Address - Phone:775-827-3746
Practice Address - Fax:775-324-1968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4-581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics