Provider Demographics
NPI:1356455307
Name:NGUYEN, PHUONG (FERN) THI THU (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG (FERN)
Middle Name:THI THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LYNN ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5705
Mailing Address - Country:US
Mailing Address - Phone:978-532-1555
Mailing Address - Fax:978-532-5519
Practice Address - Street 1:95 LYNN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5705
Practice Address - Country:US
Practice Address - Phone:978-532-1555
Practice Address - Fax:978-532-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice