MEDICARE: ROYAL DENTAL, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1043310519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL DENTAL, L.L.C.

Provider Business Mailing Address
First Line	:	2345 E. CENTENNIAL PKWY.
Second Line	:	SUITE 110
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033
Country	:	US
Telephone Number	:	702-987-1356
Fax Number	:	702-361-2876

Provider Business Practice Location Address
First Line	:	2345 E. CENTENNIAL PKWY.
Second Line	:	SUITE 110
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033
Country	:	US
Telephone Number	:	702-987-1356
Fax Number	:	702-361-2876

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. STEVEN JAMES NGUYEN
Credential	:	D.D.S.
Telephone Number	:	702-987-1356

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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