Provider Demographics
NPI:1528767100
Name:CUI, MICHELLE XUAN (DMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:XUAN
Last Name:CUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:XUAN
Other - Middle Name:
Other - Last Name:CUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 EMERALD VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4147
Mailing Address - Country:US
Mailing Address - Phone:717-503-0322
Mailing Address - Fax:
Practice Address - Street 1:1700 W CHARLESTON BLVD
Practice Address - Street 2:BUILDING D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-774-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV78041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program