Provider Demographics
NPI:1437548401
Name:BAD ASS DENTISTRY BY FRUGOLI LTD
Entity type:Organization
Organization Name:BAD ASS DENTISTRY BY FRUGOLI LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRUGOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-329-2995
Mailing Address - Street 1:1010 CAUGHLIN XING
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0612
Mailing Address - Country:US
Mailing Address - Phone:775-329-2995
Mailing Address - Fax:775-329-3671
Practice Address - Street 1:1010 CAUGHLIN XING
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0612
Practice Address - Country:US
Practice Address - Phone:775-329-2995
Practice Address - Fax:775-329-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NV2051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty