Provider Demographics
NPI:1346289139
Name:NGUYEN, TU ANH (DDS)
Entity Type:Individual
Prefix:
First Name:TU
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 LAWRENCEVILLE HWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2434
Mailing Address - Country:US
Mailing Address - Phone:770-277-0774
Mailing Address - Fax:770-277-0520
Practice Address - Street 1:1154 LAWRENCEVILLE HWY
Practice Address - Street 2:STE. 102
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2434
Practice Address - Country:US
Practice Address - Phone:770-277-0774
Practice Address - Fax:770-277-0520
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126471223G0001X
CA503351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice