Provider Demographics
NPI:1912206335
Name:KID DENTAL, LLC
Entity Type:Organization
Organization Name:KID DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-412-1070
Mailing Address - Street 1:1101 W MOANA LN
Mailing Address - Street 2:SUITE #4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4775
Mailing Address - Country:US
Mailing Address - Phone:775-412-1070
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN
Practice Address - Street 2:SUITE #4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4775
Practice Address - Country:US
Practice Address - Phone:775-412-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty