Provider Demographics
NPI:1871793828
Name:NGO, KELVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 N 51ST AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2809
Mailing Address - Country:US
Mailing Address - Phone:480-962-0662
Mailing Address - Fax:480-962-6710
Practice Address - Street 1:1161 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8823
Practice Address - Country:US
Practice Address - Phone:480-962-0662
Practice Address - Fax:480-962-6710
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice