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General NPI Number Information
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NPI Number | 1407212624
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Entity Type | Organization
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Legal Business Name | TOOTHFAIRY CHILDREN'S DENTAL
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 10925 S EASTERN AVE STE 130
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City | HENDERSON
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State | NV
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Zip | 89052-5214
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Country | US
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Telephone | 702-222-9700
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Fax | 702-309-9700
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Provider Business Mailing Address
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Address Line | 10925 S EASTERN AVE STE 130
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City | HENDERSON
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State | NV
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Zip | 89052-5214
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Country | US
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Telephone | 702-222-9700
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Fax | 702-309-9700
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MINH-NGUYEN LUONG
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Credential | DDS
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Telephone | 702-222-9700
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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 |
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License Number State |
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