Provider Demographics
NPI:1902970775
Name:NGUYEN, TRANG (DMD)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E SAINT LOUIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2525
Mailing Address - Country:US
Mailing Address - Phone:702-735-1096
Mailing Address - Fax:702-735-2490
Practice Address - Street 1:518 E SAINT LOUIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2525
Practice Address - Country:US
Practice Address - Phone:702-735-1096
Practice Address - Fax:702-735-2490
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509356Medicaid