Provider Demographics
NPI:1689711525
Name:SENGAMPHAN, NALORN NANG (DDS)
Entity Type:Individual
Prefix:MS
First Name:NALORN
Middle Name:NANG
Last Name:SENGAMPHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 US HWY 18 , STE 3,4
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-2977
Mailing Address - Fax:760-242-4686
Practice Address - Street 1:20225 MONTE VISTA ST
Practice Address - Street 2:20225 MONTE VISTA LANE
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-7534
Practice Address - Country:US
Practice Address - Phone:619-750-3556
Practice Address - Fax:619-750-3556
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist