MEDICARE: THANG NGO 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	D012597	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588554208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANG NGO DDS

Provider Business Mailing Address
First Line	:	2935 HAVASUPAI BLVD UNIT A102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-3466
Country	:	US
Telephone Number	:	510-599-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-397-7007
Fax Number	:

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

Provider Enumeration Date	:	07/04/2025
Last Update Date	:	07/21/2025

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Directions to “ THANG NGO DDS” Practice Location

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