Desert Valley Dental of Lakeside Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4858 Issued in NV

Legal business name

DESERT VALLEY DENTAL OF LAKESIDE CORP

Practice address

3665 Lakeside Dr
Reno, NV 89509-5280

Phone

(775) 825-1055

Fax

(775) 825-1084

NPI assigned

Jul 13, 2018

Organization subpart

No

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

Authorized official

Name

Robyn Goodman, DDSNPI 1598797540

Title

Owner

Phone

(775) 825-1055

Specialties & licenses 1

Addresses

Other names 1

• Desert Valley Dental of Lakeside Corp Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robyn M. Goodman, DDS

  • Dentist
  • Reno, NV
  • NPI 1598797540
  NPD Authorized official

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531440000000",
    "number": "1083190078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3665 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095280",
            "telephone_number": "775-825-1055",
            "fax_number": "775-825-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095280",
            "telephone_number": "775-825-1055",
            "fax_number": "775-825-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT VALLEY DENTAL OF LAKESIDE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-13",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-825-1055",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Valley Dental of Lakeside Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Desert Valley Dental of Lakeside Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Desert Peak Therapies
• Desert Rose Speech Therapy LLC
• Desert Sage Resource Center
• Desert Sage Resource Center
• Desert Valley Dental Damonte Inc
• Rebecca J Desfor, D.O.
• Design Wellness Inc.
• Grace Desilets, RBT
• Megan Lynn Desilva
• Rebecca Desilva

• All providers in Reno, NV
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.