=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932402278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DO NG DENTAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4280 HUALAPAI WAY 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-221-4236
-----------------------------------------------------
Fax | 702-222-0194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4280 SOUTH HUALAPAI WAY STE. 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-221-4236
-----------------------------------------------------
Fax | 702-222-0194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. TUYEN MINH DO
-----------------------------------------------------
Credential | DENTIST/ GENERAL PRA
-----------------------------------------------------
Telephone | 702-221-4236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4592
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------