Provider Demographics
NPI:1295814630
Name:NGUYEN, BAO VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MARCO DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2717
Mailing Address - Country:US
Mailing Address - Phone:727-323-0377
Mailing Address - Fax:727-323-3989
Practice Address - Street 1:3725 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8338
Practice Address - Country:US
Practice Address - Phone:727-323-0377
Practice Address - Fax:727-323-3989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN82351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice