Provider Demographics
NPI:1275749707
Name:NGUYEN, MONG-TRINH THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONG-TRINH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WEST BROADWAY
Mailing Address - Street 2:2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-925-4000
Mailing Address - Fax:212-295-4000
Practice Address - Street 1:249 W BROADWAY
Practice Address - Street 2:2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2400
Practice Address - Country:US
Practice Address - Phone:212-925-4000
Practice Address - Fax:212-295-4000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01282439Medicaid