Provider Demographics
NPI:1962885848
Name:NGUYEN, PETER SON (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SON
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 SEVEN HILLS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4375
Mailing Address - Country:US
Mailing Address - Phone:702-805-8185
Mailing Address - Fax:702-805-8185
Practice Address - Street 1:866 SEVEN HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4375
Practice Address - Country:US
Practice Address - Phone:702-805-8185
Practice Address - Fax:702-805-8185
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645731223P0221X
NVS6-1391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962885848Medicaid