Provider Demographics
NPI:1275851487
Name:NGUYEN, NICK M (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 WILLOW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5112
Mailing Address - Country:US
Mailing Address - Phone:408-293-6570
Mailing Address - Fax:408-293-6628
Practice Address - Street 1:1645 WILLOW ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5112
Practice Address - Country:US
Practice Address - Phone:408-293-6570
Practice Address - Fax:408-293-6628
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445201223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics