MEDICARE: MINH-NGUYEN LUONG, D.D.S, A PROFESSIONAL COORPORATION

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	122300000X	Dentist	3733	NV

General Provider Information

NPI Number	:	1376917476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINH-NGUYEN LUONG, D.D.S, A PROFESSIONAL COORPORATION

Provider Business Mailing Address
First Line	:	8000 W SAHARA AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7906
Country	:	US
Telephone Number	:	702-822-2300
Fax Number	:	702-309-9700

Provider Business Practice Location Address
First Line	:	8000 W SAHARA AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7906
Country	:	US
Telephone Number	:	702-822-2300
Fax Number	:	702-309-9700

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JEANSSE VILLANUEVA
Credential	:
Telephone Number	:	702-222-9700

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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