Provider Demographics
NPI:1093963852
Name:PHAN VO NGUYEN PC
Entity Type:Organization
Organization Name:PHAN VO NGUYEN PC
Other - Org Name:HAPPY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THACH
Authorized Official - Middle Name:NHU
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-399-4821
Mailing Address - Street 1:445 W. CRAIG ROAD
Mailing Address - Street 2:SUITE 121-122
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-399-9118
Mailing Address - Fax:702-633-7420
Practice Address - Street 1:445 W. CRAIG ROAD
Practice Address - Street 2:SUITE 121-122
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-399-9118
Practice Address - Fax:702-633-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty