Provider Demographics
NPI:1275561144
Name:NGUYEN, YEN THAI (DMD, PLLC)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4966
Mailing Address - Country:US
Mailing Address - Phone:336-245-2690
Mailing Address - Fax:336-245-2691
Practice Address - Street 1:2375 BREWER RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4966
Practice Address - Country:US
Practice Address - Phone:336-245-2690
Practice Address - Fax:336-245-2691
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist