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General NPI Number Information
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NPI Number | 1013245695
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Entity Type | Organization
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Legal Business Name | DAWNA PHAN PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 5061 E SAHARA AVE 1A
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City | LAS VEGAS
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State | NV
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Zip | 89142-2984
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Country | US
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Telephone | 702-641-8868
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Fax | 702-641-8865
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Provider Business Mailing Address
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Address Line | 5061 E SAHARA AVE 1A
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City | LAS VEGAS
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State | NV
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Zip | 89142-2984
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Country | US
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Telephone | 702-641-8868
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Fax | 702-641-8865
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Authorized Official
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Title or Position | CEO
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Name | DR. DAWNA PHAN
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Credential | D.M.D.
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Telephone | 714-728-0178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5483
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License Number State | NV
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