Provider Demographics
NPI:1215040118
Name:NGUYEN, PETER T (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
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 1:2006 LONG BEACH BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4958
Mailing Address - Country:US
Mailing Address - Phone:562-218-6575
Mailing Address - Fax:562-218-6572
Practice Address - Street 1:2006 LONG BEACH BLVD
Practice Address - Street 2:STE E
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4958
Practice Address - Country:US
Practice Address - Phone:562-218-6575
Practice Address - Fax:562-218-6572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice