Provider Demographics
NPI:1033579107
Name:COLLEEN NGUYEN, D.D.S., P.A.
Entity Type:Organization
Organization Name:COLLEEN NGUYEN, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-788-0800
Mailing Address - Street 1:9501 STATE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1871
Mailing Address - Country:US
Mailing Address - Phone:913-788-0800
Mailing Address - Fax:913-788-4390
Practice Address - Street 1:9501 STATE AVE STE 7
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-1871
Practice Address - Country:US
Practice Address - Phone:913-788-0800
Practice Address - Fax:913-788-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7141122300000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7551110001OtherPTAN
KS7551110001OtherPTAN