Provider Demographics
NPI:1003106519
Name:DR ALLAN T NGUYEN LLC
Entity Type:Organization
Organization Name:DR ALLAN T NGUYEN LLC
Other - Org Name:HI TECH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-962-1550
Mailing Address - Street 1:66 S DOBSON RD
Mailing Address - Street 2:STE # 144
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-969-1550
Mailing Address - Fax:480-969-5550
Practice Address - Street 1:66 S DOBSON RD
Practice Address - Street 2:STE # 144
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-969-1550
Practice Address - Fax:480-969-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210539Medicaid
AZ2053820OtherUCCI