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General NPI Number Information
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NPI Number | 1154182632
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Entity Type | Organization
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Legal Business Name | NAM M PHAN DMD PC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 10960 S EASTERN AVE STE 112
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City | HENDERSON
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State | NV
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Zip | 89052-4974
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Country | US
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Telephone | 702-209-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 2258 BUCKINGHAM CT
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City | HENDERSON
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State | NV
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Zip | 89074-5313
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Country | US
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Telephone | 702-209-9950
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NAM MINH PHAN
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Credential | DMD
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Telephone | 702-209-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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