Provider Demographics
NPI:1326767617
Name:NGUYEN, JEANNETTE EVA (DDS)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:EVA
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 1:21229 HAWTHORNE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5501
Mailing Address - Country:US
Mailing Address - Phone:714-722-5966
Mailing Address - Fax:
Practice Address - Street 1:15722 CROMWELL CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6941
Practice Address - Country:US
Practice Address - Phone:714-722-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1078041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice