MEDICARE: SMILE DENTAL, LLC

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	:	1407877921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE DENTAL, LLC

Provider Business Mailing Address
First Line	:	6775 E LAKE MEAD BLVD
Second Line	:	SUITE B9
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-1183
Country	:	US
Telephone Number	:	702-450-7971
Fax Number	:	702-898-3232

Provider Business Practice Location Address
First Line	:	6775 E LAKE MEAD BLVD
Second Line	:	SUITE B9
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-1183
Country	:	US
Telephone Number	:	702-450-7971
Fax Number	:	702-898-3232

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. RICHARD ALLEN NGUYEN
Credential	:	DMD
Telephone Number	:	702-450-7971

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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