Anthony Phan, DMD
Individual provider Active NPI General Practice Dentistry · N Las Vegas, NV
NPI 1700976552 · NPPES record last updated Apr 21, 2015
Key facts
- NPI
- 1700976552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4923 (NV)
- Practice address
- 445 W Craig Rd # 121-122
N Las Vegas, NV 89032-1230 - Phone
- (702) 399-9118
- Fax
- (702) 633-7420
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240604003306 | CA | Order and Referring Only - Dentist |
2961944053 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4923 | NV | MD | General Practice Dentistry |
Interoperability endpoints
- anthony.phan@sjffcc.eclinicaldirectplus.com
- aphan330458@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4923 | NV | Yes |
Addresses
Primary practice location
445 W Craig Rd # 121-122
N Las Vegas, NV 89032-1230
Mailing address
6116 W Flamingo Rd
Las Vegas, NV 89103-2280
Phone (702) 369-5551
Other providers in N Las Vegas, NV
- Peter L Gallarello DPM PLLC
- Tina Marie Peters
- Desiree Petersen
- Louisa Peterson
- Van K Pham
- Dawna Thien Phan
- Rameika Phillips-Mashack
- Phoenix Agency LLC
- Phoenix Rising Behavioral Health LLC
- Lisa Pier
All providers in N Las Vegas, NV · General Practice Dentistry in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.