Provider Demographics
NPI:1851460539
Name:PHEN, HUAI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUAI
Middle Name:C
Last Name:PHEN
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 1:1703 GRAYSTONE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6311
Mailing Address - Country:US
Mailing Address - Phone:415-235-0456
Mailing Address - Fax:
Practice Address - Street 1:3163 N RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4578
Practice Address - Country:US
Practice Address - Phone:702-656-2301
Practice Address - Fax:702-656-2038
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV46401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice