Provider Demographics
NPI:1194370700
Name:NGUYEN, DOMINIC DUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:DUY
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 1:427 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5012
Mailing Address - Country:US
Mailing Address - Phone:781-322-5070
Mailing Address - Fax:781-322-5073
Practice Address - Street 1:427 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5012
Practice Address - Country:US
Practice Address - Phone:781-322-5070
Practice Address - Fax:781-322-5073
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice