Provider Demographics
NPI:1114410677
Name:NGUYEN, CHRISTOPHER T (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
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 1:1645 E 50TH ST APT 14H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3197
Mailing Address - Country:US
Mailing Address - Phone:703-599-0878
Mailing Address - Fax:
Practice Address - Street 1:61 W 144TH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-2850
Practice Address - Country:US
Practice Address - Phone:708-849-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty