Provider Demographics
NPI:1164766135
Name:NGUYEN, DONG LUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:LUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BLOSSOM HILL RD STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2320
Mailing Address - Country:US
Mailing Address - Phone:408-225-5883
Mailing Address - Fax:408-225-8650
Practice Address - Street 1:120 BLOSSOM HILL RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2320
Practice Address - Country:US
Practice Address - Phone:408-225-5883
Practice Address - Fax:408-225-8650
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist