Provider Demographics
NPI:1285978981
Name:CALLAWAY-NELSON RENO MODERN DENTISTRY, PC
Entity type:Organization
Organization Name:CALLAWAY-NELSON RENO MODERN DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALLAWAY-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-851-2204
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:59 DAMONTE RANCH PKWY STE F
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-1907
Practice Address - Country:US
Practice Address - Phone:775-851-2204
Practice Address - Fax:775-851-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty