Provider Demographics
NPI:1588345409
Name:NGUYEN, PATRICK PHAT (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PHAT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:PHAT
Other - Middle Name:HONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 PEAR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4741
Mailing Address - Country:US
Mailing Address - Phone:714-622-8422
Mailing Address - Fax:
Practice Address - Street 1:240 N JONES BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1450
Practice Address - Country:US
Practice Address - Phone:702-508-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice