Healthcare Provider Details

I. General information

NPI: 1578750105
Provider Name (Legal Business Name): KATE T. NGUYEN, DDS, MS, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 SUNDOWN CREST ST
LAS VEGAS NV
89113-6602
US

IV. Provider business mailing address

6175 SUNDOWN CREST ST
LAS VEGAS NV
89113-6602
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-5614
  • Fax:
Mailing address:
  • Phone: 702-882-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4781
License Number StateNV

VIII. Authorized Official

Name: THAO NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 702-882-5614