Provider Demographics
NPI:1013182781
Name:EZ DENTAL PAHRUMP
Entity Type:Organization
Organization Name:EZ DENTAL PAHRUMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:TON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-537-0911
Mailing Address - Street 1:921 S HIGHWAY 160 STE 403
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4682
Mailing Address - Country:US
Mailing Address - Phone:775-537-0911
Mailing Address - Fax:
Practice Address - Street 1:921 S HIGHWAY 160 STE 403
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4682
Practice Address - Country:US
Practice Address - Phone:775-537-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40771223G0001X
NV46931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty