Provider Demographics
NPI:1073633434
Name:NGUYEN, TRANG THI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 SE WOODSTOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6271
Mailing Address - Country:US
Mailing Address - Phone:503-384-2799
Mailing Address - Fax:503-384-2797
Practice Address - Street 1:4429 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6271
Practice Address - Country:US
Practice Address - Phone:503-384-2799
Practice Address - Fax:503-384-2797
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice