Provider Demographics
NPI:1235423575
Name:QUYEN B NGUYEN DDS INC
Entity Type:Organization
Organization Name:QUYEN B NGUYEN DDS INC
Other - Org Name:BELLA TERRA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-224-8104
Mailing Address - Street 1:1110 W KETTLEMAN LN
Mailing Address - Street 2:SUITE 47
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6031
Mailing Address - Country:US
Mailing Address - Phone:209-224-8104
Mailing Address - Fax:209-224-8491
Practice Address - Street 1:1110 W KETTLEMAN LN
Practice Address - Street 2:SUITE 47
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6031
Practice Address - Country:US
Practice Address - Phone:209-224-8104
Practice Address - Fax:209-224-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty