Healthcare Provider Details

I. General information

NPI: 1447429808
Provider Name (Legal Business Name): ALLEN HUANG D.M.D., M.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 E HARMON AVE STE 6
LAS VEGAS NV
89121-5338
US

IV. Provider business mailing address

2430 E HARMON AVE STE 6
LAS VEGAS NV
89121-5338
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-0558
  • Fax: 702-733-1788
Mailing address:
  • Phone: 702-733-0558
  • Fax: 702-733-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-51
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-53
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-121
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-31
License Number StateNV

VIII. Authorized Official

Name: DR. ALLEN WL HUANG
Title or Position: PERIODONTIST
Credential: DMD, MS
Phone: 702-733-0558