Provider Demographics
NPI:1275697302
Name:HONG, RANDY (DDS)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 SIMMONS ST STE 4
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9001
Mailing Address - Country:US
Mailing Address - Phone:702-638-1005
Mailing Address - Fax:702-638-1071
Practice Address - Street 1:5465 SIMMONS ST STE 4
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-9001
Practice Address - Country:US
Practice Address - Phone:702-638-1005
Practice Address - Fax:702-638-1071
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice