Provider Demographics
NPI:1295819894
Name:DRAGON DENTAL, INC.
Entity type:Organization
Organization Name:DRAGON DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-782-9755
Mailing Address - Street 1:1234 WATERLOO LN
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-7373
Mailing Address - Country:US
Mailing Address - Phone:775-782-9755
Mailing Address - Fax:775-782-4812
Practice Address - Street 1:1234 WATERLOO LN
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7373
Practice Address - Country:US
Practice Address - Phone:775-782-9755
Practice Address - Fax:775-782-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty