Provider Demographics
NPI:1326253527
Name:NGUYEN, BAO CHAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:CHAU
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 1:210 SO. WATER ST.
Mailing Address - Street 2:SUITE 616
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204
Mailing Address - Country:US
Mailing Address - Phone:414-347-0456
Mailing Address - Fax:
Practice Address - Street 1:8651 S MARKET PL
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3523
Practice Address - Country:US
Practice Address - Phone:414-764-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist