Provider Demographics
NPI:1699415349
Name:AVENDANO, DENNEZ (DMD)
Entity type:Individual
Prefix:
First Name:DENNEZ
Middle Name:
Last Name:AVENDANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 VISTA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-4168
Mailing Address - Country:US
Mailing Address - Phone:775-626-3535
Mailing Address - Fax:
Practice Address - Street 1:850 VISTA BLVD
Practice Address - Street 2:#100
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-4168
Practice Address - Country:US
Practice Address - Phone:775-626-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice