Healthcare Provider Details

I. General information

NPI: 1962885848
Provider Name (Legal Business Name): PETER SON NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 SEVEN HILLS DR STE 102
HENDERSON NV
89052-4375
US

IV. Provider business mailing address

866 SEVEN HILLS DR STE 102
HENDERSON NV
89052-4375
US

V. Phone/Fax

Practice location:
  • Phone: 702-805-8185
  • Fax: 702-805-8185
Mailing address:
  • Phone: 702-805-8185
  • Fax: 702-805-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number64573
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-139
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: