Provider Demographics
NPI:1235258310
Name:NGUYEN, DAI CHINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAI
Middle Name:CHINH
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 1:8145 ELK GROVE BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5966
Mailing Address - Country:US
Mailing Address - Phone:916-691-2226
Mailing Address - Fax:916-691-2227
Practice Address - Street 1:8145 ELK GROVE BLVD STE 18
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5966
Practice Address - Country:US
Practice Address - Phone:916-691-2226
Practice Address - Fax:916-691-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice