Provider Demographics
NPI:1821802448
Name:ATLAS DENTAL LLC
Entity type:Organization
Organization Name:ATLAS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-519-4801
Mailing Address - Street 1:2060 EXPERIENCE AVE UNIT 541
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1397
Mailing Address - Country:US
Mailing Address - Phone:760-519-4801
Mailing Address - Fax:
Practice Address - Street 1:4844 SPARKS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8163
Practice Address - Country:US
Practice Address - Phone:760-519-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental