Provider Demographics
NPI:1104331081
Name:SUMMIT SMILES
Entity type:Organization
Organization Name:SUMMIT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-846-4777
Mailing Address - Street 1:10595 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8909
Mailing Address - Country:US
Mailing Address - Phone:775-825-8463
Mailing Address - Fax:775-332-8466
Practice Address - Street 1:10595 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8909
Practice Address - Country:US
Practice Address - Phone:775-825-8463
Practice Address - Fax:775-332-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0664OtherNEVADA DENTAL BOARD OF EXAMINERS