Provider Demographics
NPI:1346451762
Name:BRANDON T. NGUYEN, DMD, INC.
Entity Type:Organization
Organization Name:BRANDON T. NGUYEN, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-599-3838
Mailing Address - Street 1:1360 E ANAHEIM ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5514
Mailing Address - Country:US
Mailing Address - Phone:562-599-3838
Mailing Address - Fax:562-599-6818
Practice Address - Street 1:1360 E ANAHEIM ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5514
Practice Address - Country:US
Practice Address - Phone:562-599-3838
Practice Address - Fax:562-599-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47973261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9312401Medicare ID - Type Unspecified