Provider Demographics
NPI:1164440780
Name:NGUYEN, HENRY CHUONG (DMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:CHUONG
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 1:1394 INDIAN TRAIL LILBURN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2677
Mailing Address - Country:US
Mailing Address - Phone:770-921-9792
Mailing Address - Fax:770-921-9009
Practice Address - Street 1:1394 INDIAN TRAIL LILBURN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2677
Practice Address - Country:US
Practice Address - Phone:770-921-9792
Practice Address - Fax:770-921-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115631223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39100OtherAVESIS
GA9180327OtherDORAL
GA00714172AMedicaid