Provider Demographics
NPI:1093869281
Name:NGUYEN, TRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14747 W VENTURA ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7422
Mailing Address - Country:US
Mailing Address - Phone:817-933-1792
Mailing Address - Fax:
Practice Address - Street 1:3901 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2114
Practice Address - Country:US
Practice Address - Phone:602-278-1837
Practice Address - Fax:602-278-7752
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137713Medicaid