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General NPI Number Information
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NPI Number | 1902941032
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Entity Type | Organization
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Legal Business Name | MAN NGUYEN PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6115 S. RAINBOW BOULEVARD SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89118
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Country | US
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Telephone | 702-227-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 6115 S. RAINBOW BOULEVARD SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89118
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Country | US
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Telephone | 702-227-7964
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAN DINH NGUYEN
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Credential | D.M.D.
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Telephone | 702-227-7964
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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 | 4886
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License Number State | NV
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