Provider Demographics
NPI:1356047666
Name:RENO-SPARKS CLINIC HEALTH
Entity type:Organization
Organization Name:RENO-SPARKS CLINIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:ORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:775-329-5162
Mailing Address - Street 1:1715 KUENZLI ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1117
Mailing Address - Country:US
Mailing Address - Phone:775-329-5162
Mailing Address - Fax:
Practice Address - Street 1:1715 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1117
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497700801Medicaid