Provider Demographics
NPI:1316269541
Name:DESERT VALLEY DENTAL OF RENO
Entity type:Organization
Organization Name:DESERT VALLEY DENTAL OF RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:EBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-673-1055
Mailing Address - Street 1:5295 SUN VALLEY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7955
Mailing Address - Country:US
Mailing Address - Phone:775-673-1055
Mailing Address - Fax:775-673-1059
Practice Address - Street 1:5295 SUN VALLEY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-7955
Practice Address - Country:US
Practice Address - Phone:775-673-1055
Practice Address - Fax:775-673-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty