MEDICARE: DR. BRYAN NGUYEN BANG HOANG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6665	NV

General Provider Information

NPI Number	:	1184030710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN NGUYEN BANG HOANG DMD

Provider Business Mailing Address
First Line	:	7171 W CRAIG RD # 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6018
Country	:	US
Telephone Number	:	702-655-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 W CRAIG RD # 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6018
Country	:	US
Telephone Number	:	702-655-0331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	03/16/2017

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