Provider Demographics
NPI:1477640290
Name:NGUYEN, BRIAN DZUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DZUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:DUNG
Other - Middle Name:MANH ANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 E SILVERADO RANCH BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6204
Mailing Address - Country:US
Mailing Address - Phone:702-263-8820
Mailing Address - Fax:702-914-8121
Practice Address - Street 1:450 E SILVERADO RANCH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6204
Practice Address - Country:US
Practice Address - Phone:702-263-8820
Practice Address - Fax:702-914-8121
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48561223G0001X
AZ61901223G0001X
CA58907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist