Provider Demographics
NPI:1174673024
Name:NGUYEN, TAO DUY (DDS)
Entity Type:Individual
Prefix:
First Name:TAO
Middle Name:DUY
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 1:4947 MILLS ST APT C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9328
Mailing Address - Country:US
Mailing Address - Phone:619-402-5607
Mailing Address - Fax:
Practice Address - Street 1:583 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-6449
Practice Address - Country:US
Practice Address - Phone:619-440-6222
Practice Address - Fax:619-440-6999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice