Provider Demographics
NPI:1316383409
Name:NGUYEN, MAI-TRINH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAI-TRINH
Middle Name:
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 1:6552 BOLSA AVENUE, STE. L
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-893-4118
Mailing Address - Fax:714-893-3015
Practice Address - Street 1:6552 BOLSA AVENUE, STE. L
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-893-4118
Practice Address - Fax:714-893-3015
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist