Provider Demographics
NPI:1275971921
Name:NGUYEN, THAO THI-THANH (DMD)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:THI-THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-9035
Mailing Address - Country:US
Mailing Address - Phone:920-869-2711
Mailing Address - Fax:
Practice Address - Street 1:525 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-9035
Practice Address - Country:US
Practice Address - Phone:920-869-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7093-151223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health