Provider Demographics
NPI:1063682268
Name:NGUYEN, BICH-NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:BICH-NGOC
Middle Name:
Last Name:NGUYEN
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 1:345 ESTUDILLO AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4702
Mailing Address - Country:US
Mailing Address - Phone:510-352-3034
Mailing Address - Fax:
Practice Address - Street 1:345 ESTUDILLO AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4702
Practice Address - Country:US
Practice Address - Phone:510-352-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist