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General NPI Number Information
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NPI Number | 1801939608
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Entity Type | Organization
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Legal Business Name | XA D.D.S., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10217 W CHARLESTON BLVD SUITE B
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City | LAS VEGAS
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State | NV
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Zip | 89135-1021
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Country | US
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Telephone | 702-456-6678
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Fax |
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Provider Business Mailing Address
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Address Line | 6720 N DURANGO DR SUITE 260
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City | LAS VEGAS
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State | NV
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Zip | 89149-4434
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Country | US
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Telephone | 702-893-2288
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Fax | 702-893-2033
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TRUNG Q XA
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Credential | DDS
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Telephone | 702-456-6678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4644
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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 | 4623
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License Number State | NV
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