Provider Demographics
NPI:1861797425
Name:AMANJIT DHATT, MD, LLC
Entity type:Organization
Organization Name:AMANJIT DHATT, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMANJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-250-5972
Mailing Address - Street 1:2745 SPINNAKER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-5759
Mailing Address - Country:US
Mailing Address - Phone:775-250-5972
Mailing Address - Fax:
Practice Address - Street 1:199 KIRMAN AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1438
Practice Address - Country:US
Practice Address - Phone:775-440-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X
NV13406261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty