MEDICARE: PEARLY WHITES LV CORP.

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	4352	NV

General Provider Information

NPI Number	:	1982649190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLY WHITES LV CORP.

Provider Business Mailing Address
First Line	:	3376 S EASTERN AVE
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3380
Country	:	US
Telephone Number	:	702-734-2499
Fax Number	:	702-734-2730

Provider Business Practice Location Address
First Line	:	3376 S EASTERN AVE
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3380
Country	:	US
Telephone Number	:	702-734-2499
Fax Number	:	702-734-2730

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CAT-HIEN T NGUYEN
Credential	:	DDS
Telephone Number	:	702-734-2499

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/22/2020

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