Provider Demographics
NPI:1366856510
Name:NGUYEN, DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
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 1:1030 SW JEFFERSON ST APT 439
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3467
Mailing Address - Country:US
Mailing Address - Phone:512-431-2965
Mailing Address - Fax:
Practice Address - Street 1:10300 SE WASHINGTON ST STE C101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2805
Practice Address - Country:US
Practice Address - Phone:503-776-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299071223G0001X
ORD11776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD11776OtherOREGON DENTAL LICENSE