Provider Demographics
NPI:1396872867
Name:DUONG, LAN THANH (DDS)
Entity type:Individual
Prefix:MRS
First Name:LAN
Middle Name:THANH
Last Name:DUONG
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 1:211 N BUFFALO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0302
Mailing Address - Country:US
Mailing Address - Phone:702-869-8858
Mailing Address - Fax:702-869-5588
Practice Address - Street 1:211 N BUFFALO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0302
Practice Address - Country:US
Practice Address - Phone:702-869-8858
Practice Address - Fax:702-869-5588
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3574122300000X
CA45249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist