MEDICARE: DR. PHU CONG LUONG 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	1223G0001X	General Practice Dentistry	3527	NV

General Provider Information

NPI Number	:	1659488492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHU CONG LUONG DDS

Provider Business Mailing Address
First Line	:	4850 S FORT APACHE RD
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7963
Country	:	US
Telephone Number	:	702-255-9154
Fax Number	:	702-255-0857

Provider Business Practice Location Address
First Line	:	4850 S FORT APACHE RD
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7963
Country	:	US
Telephone Number	:	702-255-9154
Fax Number	:	702-255-0857

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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