Summit Boulevard Dental

Primary specialty

DentistTaxonomy code 122300000X

License

S7-88C Issued in NV

Legal business name

SUMMIT BOULEVARD DENTAL

Practice address

13985 S Virginia St Ste 806
Reno, NV 89511-8934

Phone

(775) 846-4777

Fax

(775) 525-5512

NPI assigned

Apr 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy Adams, DMD

Title

Owner

Phone

(615) 601-4728

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1063900595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13985 S VIRGINIA ST STE 806",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895118934",
            "telephone_number": "775-846-4777",
            "fax_number": "775-525-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13985 S VIRGINIA ST STE 806",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895118934",
            "telephone_number": "775-846-4777",
            "fax_number": "775-525-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT BOULEVARD DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-30",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-601-4728",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NV",
            "license": "S7-88C",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "NV",
            "license": "S7-881",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTISTRY",
            "identifier": "1306026679",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Reno, NV
• Providers in Reno, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.