Provider Demographics
NPI:1104213255
Name:NGUYEN, AN NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:NGOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1888 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2357
Mailing Address - Country:US
Mailing Address - Phone:860-768-9062
Mailing Address - Fax:
Practice Address - Street 1:1888 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2357
Practice Address - Country:US
Practice Address - Phone:860-768-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CT116421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program