Provider Demographics
NPI:1285653758
Name:NGUYEN, TRUC THANH (DDS)
Entity Type:Individual
Prefix:
First Name:TRUC
Middle Name:THANH
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 1:32700 ALVARADO BLVD
Mailing Address - Street 2:15931 HESPERIAN BLVD SAN LORENZO, CA 94580
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1202
Mailing Address - Country:US
Mailing Address - Phone:510-477-0811
Mailing Address - Fax:
Practice Address - Street 1:32700 ALVARADO BLVD
Practice Address - Street 2:15931 HESPERIAN BLVD SAN LORENZO, CA 94580
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1202
Practice Address - Country:US
Practice Address - Phone:510-477-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43214OtherDENTI-CAL