Provider Demographics
NPI:1407212624
Name:TOOTHFAIRY CHILDREN'S DENTAL
Entity Type:Organization
Organization Name:TOOTHFAIRY CHILDREN'S DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINH-NGUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-222-9700
Mailing Address - Street 1:10925 S EASTERN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5214
Mailing Address - Country:US
Mailing Address - Phone:702-222-9700
Mailing Address - Fax:702-309-9700
Practice Address - Street 1:10925 S EASTERN AVE STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5214
Practice Address - Country:US
Practice Address - Phone:702-222-9700
Practice Address - Fax:702-309-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty