Provider Demographics
NPI:1326424003
Name:NGUYEN, ADRIENNE MY-TRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:MY-TRAM
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 1:899 BARRON AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2613
Mailing Address - Country:US
Mailing Address - Phone:650-353-1105
Mailing Address - Fax:
Practice Address - Street 1:3775 BEACON AVE STE 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1466
Practice Address - Country:US
Practice Address - Phone:510-791-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648841223P0221X
MADL148311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry