Provider Demographics
NPI:1952372708
Name:STEAD DENTAL CLINIC
Entity Type:Organization
Organization Name:STEAD DENTAL CLINIC
Other - Org Name:NORTH HILLS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:DEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-677-1055
Mailing Address - Street 1:1055 N HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-8691
Mailing Address - Country:US
Mailing Address - Phone:775-677-1055
Mailing Address - Fax:775-677-1081
Practice Address - Street 1:1055 N HILLS BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-8691
Practice Address - Country:US
Practice Address - Phone:775-677-1055
Practice Address - Fax:775-677-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty