Provider Demographics
NPI:1235698820
Name:NHAN DANG NGUYEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:NHAN DANG NGUYEN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-319-5858
Mailing Address - Street 1:5940 SHOVELER CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2933
Mailing Address - Country:US
Mailing Address - Phone:909-319-5858
Mailing Address - Fax:
Practice Address - Street 1:9972 BOLSA AVE STE 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6069
Practice Address - Country:US
Practice Address - Phone:909-319-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty