Provider Demographics
NPI:1265503940
Name:VICKY NGUYEN DDS PC
Entity Type:Organization
Organization Name:VICKY NGUYEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-431-9578
Mailing Address - Street 1:969 WINDY HILL ROAD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-431-9578
Mailing Address - Fax:770-438-2919
Practice Address - Street 1:969 WINDY HILL ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-431-9578
Practice Address - Fax:770-438-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011814122300000X
CA44962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100488OtherAVESIS
GA108026OtherDORAL
GA9180328OtherDORAL
GA00802194BMedicaid
GA166402OtherDORAL
GA39274OtherAVESIS