MEDICARE: DR. HUNG NGOC DANG 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	1223G0001X	General Practice Dentistry	3520	NV
2	1223G0001X	General Practice Dentistry	45239	CA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	45239	CA

General Provider Information

NPI Number	:	1659465391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUNG NGOC DANG DDS

Provider Business Mailing Address
First Line	:	4001 S DECATUR BLVD STE 42B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5859
Country	:	US
Telephone Number	:	702-501-5818
Fax Number	:	888-870-9859

Provider Business Practice Location Address
First Line	:	4001 S DECATUR BLVD STE 42B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5859
Country	:	US
Telephone Number	:	702-501-5818
Fax Number	:	702-501-5818

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/13/2020

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