Provider Demographics
NPI:1013223429
Name:NGO, TAM THANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:THANH
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 BOLSA AVE # A1
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6713
Mailing Address - Country:US
Mailing Address - Phone:714-839-6631
Mailing Address - Fax:
Practice Address - Street 1:10051 BOLSA AVE # A1
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6713
Practice Address - Country:US
Practice Address - Phone:714-839-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist