MEDICARE: VINH- THY NGUYEN DDS

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	1223E0200X	Endodontics	S7-46	NV
2	1223E0200X	Endodontics	48343	CA

General Provider Information

NPI Number	:	1356431142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINH- THY NGUYEN DDS

Provider Business Mailing Address
First Line	:	9550 S EASTERN AVE STE 248
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8041
Country	:	US
Telephone Number	:	702-384-0053
Fax Number	:	702-269-6063

Provider Business Practice Location Address
First Line	:	9550 S EASTERN AVE STE 248
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8041
Country	:	US
Telephone Number	:	702-384-0053
Fax Number	:	702-269-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/23/2013

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