Provider Demographics
NPI:1396196051
Name:JOHN T NGUYEN DDS INC
Entity Type:Organization
Organization Name:JOHN T NGUYEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THAI-HUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-227-4477
Mailing Address - Street 1:1175 BAKER ST
Mailing Address - Street 2:A4
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4101
Mailing Address - Country:US
Mailing Address - Phone:714-227-4477
Mailing Address - Fax:
Practice Address - Street 1:1175 BAKER ST
Practice Address - Street 2:A4
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4101
Practice Address - Country:US
Practice Address - Phone:714-227-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty