Provider Demographics
NPI:1093012494
Name:QUOC L. NGUYEN, D.D.S. A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:QUOC L. NGUYEN, D.D.S. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:LAGUNA HILLS ORAL MAXILLOFACIAL & IMPLANT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:LAP
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-768-4071
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:STE 1 C
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4394
Mailing Address - Country:US
Mailing Address - Phone:949-768-4071
Mailing Address - Fax:949-768-0292
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:STE 1 C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4394
Practice Address - Country:US
Practice Address - Phone:949-768-4071
Practice Address - Fax:949-768-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59352261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery