Provider Demographics
NPI:1316510001
Name:INCLINE DENTAL CARE, LLC
Entity type:Organization
Organization Name:INCLINE DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-409-4614
Mailing Address - Street 1:3605 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5301
Mailing Address - Country:US
Mailing Address - Phone:775-409-4614
Mailing Address - Fax:
Practice Address - Street 1:231 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9415
Practice Address - Country:US
Practice Address - Phone:775-831-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty