Provider Demographics
NPI:1366641896
Name:NGUYEN, EMILY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
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 1:2900 STANDIFORD AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0167
Mailing Address - Country:US
Mailing Address - Phone:209-579-0446
Mailing Address - Fax:209-572-5095
Practice Address - Street 1:2900 STANDIFORD AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0167
Practice Address - Country:US
Practice Address - Phone:209-579-0446
Practice Address - Fax:209-572-5095
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice