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General NPI Number Information
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NPI Number | 1760099584
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Entity Type | Organization
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Legal Business Name | ANTHONY Q. NGO, DMD, PROSSIONAL CORPORATION
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 1975 W CRAIG RD STE 103
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City | N LAS VEGAS
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State | NV
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Zip | 89032-0332
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Country | US
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Telephone | 702-220-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 SILVERSPUR LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1503
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Country | US
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Telephone | 714-342-0121
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KELLY JIN
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Credential | DMD
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Telephone | 714-342-0121
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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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