Provider Demographics
NPI:1104217629
Name:NGUYEN, SON X (DMD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:X
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2901
Mailing Address - Country:US
Mailing Address - Phone:408-828-3863
Mailing Address - Fax:408-531-8088
Practice Address - Street 1:3005 SILVER CREEK RD
Practice Address - Street 2:SUITE 198
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1789
Practice Address - Country:US
Practice Address - Phone:408-828-3863
Practice Address - Fax:408-531-8088
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice