Provider Demographics
NPI:1083784441
Name:NGUYEN AND TA PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:NGUYEN AND TA PROFESSIONAL DENTAL CORP
Other - Org Name:ALLAN NGUYEN, DDS, MS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:909-397-7855
Mailing Address - Street 1:2135 N TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2422
Mailing Address - Country:US
Mailing Address - Phone:909-397-7855
Mailing Address - Fax:909-397-7522
Practice Address - Street 1:2135 N TOWNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2422
Practice Address - Country:US
Practice Address - Phone:909-397-7855
Practice Address - Fax:909-397-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty