NPIMap

Organization Active NPI

Summit Smiles

  • General Practice Dentistry
  • Reno, NV
National Provider Identifier
1104331081
Registry record updated Dec 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4783 Issued in NV
Legal business name
SUMMIT SMILES
Practice address
10595 Double R Blvd
Reno, NV 89521-8909
Phone
(775) 825-8463
Fax
(775) 332-8466
NPI assigned
Dec 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2017

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

Authorized official

Name
Angela Golden
Title
Management Consultant
Phone
(775) 846-4777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 4783 NV Primary

Addresses

Primary practice location

10595 Double R Blvd
Reno, NV 89521-8909

Mailing address

10595 Double R Blvd
Reno, NV 89521-8909
Phone (775) 825-8463

Other identifiers 1

IdentifierTypeStateIssuer
0664OtherNVNEVADA DENTAL BOARD OF EXAMINERS

National Provider Directory

National Provider Directory

Locations

10595 Double R Blvd
Reno, NV 89521
Phone (775) 825-8463

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513123200000",
    "number": "1104331081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10595 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218909",
            "telephone_number": "775-825-8463",
            "fax_number": "775-332-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10595 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218909",
            "telephone_number": "775-825-8463",
            "fax_number": "775-332-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2017-12-13",
        "status": "A",
        "authorized_official_last_name": "GOLDEN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "MANAGEMENT CONSULTANT",
        "authorized_official_telephone_number": "775-846-4777"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA DENTAL BOARD OF EXAMINERS",
            "identifier": "0664",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; 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.