Provider Demographics
NPI:1003092024
Name:NGUYEN, THOMAS K (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30512 MISSION BLVD
Mailing Address - Street 2:#100
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7417
Mailing Address - Country:US
Mailing Address - Phone:510-471-1500
Mailing Address - Fax:510-471-9554
Practice Address - Street 1:30512 MISSION BLVD
Practice Address - Street 2:#100
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-7417
Practice Address - Country:US
Practice Address - Phone:510-471-1500
Practice Address - Fax:510-471-9554
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice