Provider Demographics
NPI:1356469639
Name:THUY-MAI NGUYEN, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:THUY-MAI NGUYEN, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:THUY-MAI NGUYEN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY-MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-263-6646
Mailing Address - Street 1:1418 DEMPSEY RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6977
Mailing Address - Country:US
Mailing Address - Phone:408-263-6646
Mailing Address - Fax:
Practice Address - Street 1:1418 DEMPSEY RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6977
Practice Address - Country:US
Practice Address - Phone:408-263-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36809OtherCA DENTAL BOARD LICENSE
CAG98165-01OtherCA DELTA HEALTHY FAMILY
CAB36809-01Medicaid