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General NPI Number Information
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NPI Number | 1710307392
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Entity Type | Individual
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Provider Name | LONG NGUYEN DMD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 08/07/2016
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Provider Practice Location Address
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Address Line | 150 S HIGHWAY 160 STE C-11
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City | PAHRUMP
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State | NV
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Zip | 89048-2176
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Country | US
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Telephone | 775-727-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 TANGIERS DR
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City | HENDERSON
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State | NV
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Zip | 89012-7239
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Country | US
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Telephone | 702-328-1427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | S7-92
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6767
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License Number State | NV
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