MEDICARE: DR. SUZIE NGUYEN-SU 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	3077	NV
2	1223G0001X	General Practice Dentistry	41858	CA

General Provider Information

NPI Number	:	1700897733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZIE NGUYEN-SU DDS

Provider Business Mailing Address
First Line	:	2451 PROFESSIONAL COURT
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:	702-240-6545

Provider Business Practice Location Address
First Line	:	2451 PROFESSIONAL COURT
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:	702-240-6545

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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