Provider Demographics
NPI:1083628374
Name:LAC, AARON V (DMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:V
Last Name:LAC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LUONG
Other - Middle Name:HUU
Other - Last Name:LAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 PINE BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-838-9277
Mailing Address - Fax:
Practice Address - Street 1:10170 WEST TROPICANA AVE
Practice Address - Street 2:SUITE #155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-248-0081
Practice Address - Fax:702-248-7123
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1606724OtherUNITE CONCORDIA DMR
NV100503172Medicaid
NV100503172Medicaid