Provider Demographics
NPI:1083823751
Name:LUAN D NGUYEN, DDS, INC.
Entity Type:Organization
Organization Name:LUAN D NGUYEN, DDS, INC.
Other - Org Name:LAKE FOREST DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUAN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-595-4322
Mailing Address - Street 1:26700 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2844
Mailing Address - Country:US
Mailing Address - Phone:949-595-4322
Mailing Address - Fax:949-398-0199
Practice Address - Street 1:26700 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2844
Practice Address - Country:US
Practice Address - Phone:949-595-4322
Practice Address - Fax:949-398-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty