Healthcare Provider Details

I. General information

NPI: 1376041053
Provider Name (Legal Business Name): PHONG TRAN CAO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E SILVERADO RANCH BLVD STE 100
LAS VEGAS NV
89183-7517
US

IV. Provider business mailing address

700 E SILVERADO RANCH BLVD STE 100
LAS VEGAS NV
89183-7517
US

V. Phone/Fax

Practice location:
  • Phone: 702-366-6115
  • Fax:
Mailing address:
  • Phone: 702-366-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5898
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5898
License Number StateNV

VIII. Authorized Official

Name: DR. PHONG TRAN CAO
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 702-366-6115