MEDICARE: NORTH LAS VEGAS DENTAL GROUP

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	4555	NV

General Provider Information

NPI Number	:	1417394842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LAS VEGAS DENTAL GROUP

Provider Business Mailing Address
First Line	:	3376 S EASTERN AVE STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3367
Country	:	US
Telephone Number	:	702-802-3500
Fax Number	:	702-802-3502

Provider Business Practice Location Address
First Line	:	3376 S EASTERN AVE STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3367
Country	:	US
Telephone Number	:	702-802-3500
Fax Number	:	702-802-3502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS TRINH
Credential	:	DDS
Telephone Number	:	702-802-3500

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	05/24/2013

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