Provider Demographics
NPI:1306044375
Name:QUOC NGUYEN & TRUNG NGUYEN, DDS
Entity Type:Organization
Organization Name:QUOC NGUYEN & TRUNG NGUYEN, DDS
Other - Org Name:HARBOR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:THU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-531-4311
Mailing Address - Street 1:756 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2337
Mailing Address - Country:US
Mailing Address - Phone:714-531-4311
Mailing Address - Fax:714-531-0756
Practice Address - Street 1:756 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2337
Practice Address - Country:US
Practice Address - Phone:714-531-4311
Practice Address - Fax:714-531-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44429261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-92183-01Medicaid