MEDICARE: SUZIE NGUYEN-SU, DDS., LTD

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

General Provider Information

NPI Number	:	1780346858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZIE NGUYEN-SU, DDS., LTD

Provider Business Mailing Address
First Line	:	2451 PROFESSIONAL CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 PROFESSIONAL CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUZIE NGUYEN-SU
Credential	:
Telephone Number	:	702-480-5777

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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