Provider Demographics
NPI:1801939608
Name:XA D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:XA D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:XA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-456-6678
Mailing Address - Street 1:6720 N DURANGO DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4434
Mailing Address - Country:US
Mailing Address - Phone:702-893-2288
Mailing Address - Fax:702-893-2033
Practice Address - Street 1:10217 W CHARLESTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1021
Practice Address - Country:US
Practice Address - Phone:702-456-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV46441223G0001X
NV46231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty