Individual
DR. RYAN FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1700 W. CHARLESTON BLVD, M/S 7424, LAS VEGAS, NV 89102-2335
(702) 774-5175
(702) 774-2812
Mailing address
1700 W. CHARLESTON BLVD, M/S 7424, LAS VEGAS, NV 89102-2335
(702) 774-5175
(702) 774-2812
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7477
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/04/2021
Last updated
06/08/2021
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