MEDICARE: TAYLOR THAO NGUYEN DDS

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	122300000X	Dentist	7666	NV

General Provider Information

NPI Number	:	1346977683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR THAO NGUYEN DDS

Provider Business Mailing Address
First Line	:	4201 S DECATUR BLVD APT 2108
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5886
Country	:	US
Telephone Number	:	405-465-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 W SAHARA AVE
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-680-1525
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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