Provider Demographics
NPI:1417971672
Name:NGUYEN, DIEM CONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIEM
Middle Name:CONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 N JONES BLVD
Mailing Address - Street 2:#4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4861
Mailing Address - Country:US
Mailing Address - Phone:702-645-7310
Mailing Address - Fax:702-645-3018
Practice Address - Street 1:3220 N JONES BLVD
Practice Address - Street 2:#4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4861
Practice Address - Country:US
Practice Address - Phone:702-645-7310
Practice Address - Fax:702-645-3018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4732T122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist