Provider Demographics
NPI:1154067999
Name:A MATTHEW NGUYEN DDS CORP.
Entity Type:Organization
Organization Name:A MATTHEW NGUYEN DDS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:RED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-847-9191
Mailing Address - Street 1:6712 HILO AVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8841
Mailing Address - Country:US
Mailing Address - Phone:501-765-7689
Mailing Address - Fax:
Practice Address - Street 1:6712 HILO AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-8841
Practice Address - Country:US
Practice Address - Phone:501-765-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4131OtherDENTAL OFFICE