Provider Demographics
NPI:1073785382
Name:DIEM H. NGUYEN, D.D.S, P.C
Entity Type:Organization
Organization Name:DIEM H. NGUYEN, D.D.S, P.C
Other - Org Name:CHANTILLY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-467-0214
Mailing Address - Street 1:3901 CENTERVIEW DR
Mailing Address - Street 2:SUITE #T
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3228
Mailing Address - Country:US
Mailing Address - Phone:703-467-0214
Mailing Address - Fax:703-467-0568
Practice Address - Street 1:3901 CENTERVIEW DR
Practice Address - Street 2:SUITE #T
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3228
Practice Address - Country:US
Practice Address - Phone:703-467-0214
Practice Address - Fax:703-467-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty