Provider Demographics
NPI:1023771029
Name:NGUYEN, ELIZABETH (DMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NGUYEN
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 1:9774 SONORA BEND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:916-429-5757
Mailing Address - Fax:
Practice Address - Street 1:3830 E FLAMINGO RD
Practice Address - Street 2:E2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6234
Practice Address - Country:US
Practice Address - Phone:702-291-2031
Practice Address - Fax:702-984-7566
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist