MEDICARE: PHAN & HONG DMD P.C

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	4923	NV

General Provider Information

NPI Number	:	1235455940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAN & HONG DMD P.C

Provider Business Mailing Address
First Line	:	6116 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2280
Country	:	US
Telephone Number	:	702-369-5551
Fax Number	:	702-367-3406

Provider Business Practice Location Address
First Line	:	6116 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2280
Country	:	US
Telephone Number	:	702-369-5551
Fax Number	:	702-367-3406

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANTHONY PHAN
Credential	:	DMD
Telephone Number	:	702-369-5551

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/21/2015

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