Provider Demographics
NPI:1811403900
Name:NORTHERN NEVADA FAMILY DENTAL
Entity Type:Organization
Organization Name:NORTHERN NEVADA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LITTLEJOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-626-7772
Mailing Address - Street 1:5901 S LOS ALTOS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7667
Mailing Address - Country:US
Mailing Address - Phone:775-626-7772
Mailing Address - Fax:775-626-7811
Practice Address - Street 1:5901 S LOS ALTOS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7667
Practice Address - Country:US
Practice Address - Phone:775-626-7772
Practice Address - Fax:775-626-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5122261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental