MEDICARE: TRANG NGUYEN DMD

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	4709	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902970775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANG NGUYEN DMD

Provider Business Mailing Address
First Line	:	518 E SAINT LOUIS AVE
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2525
Country	:	US
Telephone Number	:	702-735-1096
Fax Number	:	702-735-2490

Provider Business Practice Location Address
First Line	:	518 E SAINT LOUIS AVE
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2525
Country	:	US
Telephone Number	:	702-735-1096
Fax Number	:	702-735-2490

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	05/30/2008

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Directions to “ TRANG NGUYEN DMD” Practice Location

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