Provider Demographics
NPI:1265059273
Name:DUONG, WENDY B (DMD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:DUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8948 WILLOW BREAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5096
Mailing Address - Country:US
Mailing Address - Phone:510-637-9917
Mailing Address - Fax:
Practice Address - Street 1:175 N STEPHANIE ST STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8998
Practice Address - Country:US
Practice Address - Phone:510-637-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist