Provider Demographics
NPI:1003908534
Name:NGUYEN, MONGLIEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONGLIEN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLIEN
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3240 14TH AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8509
Mailing Address - Country:US
Mailing Address - Phone:360-866-7669
Mailing Address - Fax:360-866-9115
Practice Address - Street 1:3240 14TH AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8509
Practice Address - Country:US
Practice Address - Phone:360-866-7669
Practice Address - Fax:360-866-9115
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA94021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice