MEDICARE: DAVEY TRUONG DMD

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	7504	NV

General Provider Information

NPI Number	:	1750054235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVEY TRUONG DMD

Provider Business Mailing Address
First Line	:	9550 W SAHARA AVE APT 2045
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5385
Country	:	US
Telephone Number	:	510-499-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	8035 S RAINBOW BLVD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6549
Country	:	US
Telephone Number	:	702-896-7211
Fax Number	:

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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Directions to “ DAVEY TRUONG DMD” Practice Location

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