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NPI Code Detail

MEDICARE: DR. NAM MINH PHAN DMD

MEDICARE: DR. NAM MINH PHAN 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
1122300000XDentist6033NV

General Provider Information

NPI Number : 1881924298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NAM MINH PHAN DMD
Provider Business Mailing Address
First Line : 4318 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6016
Country : US
Telephone Number : 310-955-0683
Fax Number :
Provider Business Practice Location Address
First Line : 366 W LAKE MEAD PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7287
Country : US
Telephone Number : 702-209-9950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2010
Last Update Date : 01/06/2026

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Directions to “ DR. NAM MINH PHAN DMD” Practice Location

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