Provider Demographics
NPI:1407304959
Name:PHAN, NGUYEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 E INDIAN BEND RD STE 128
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4820
Mailing Address - Country:US
Mailing Address - Phone:602-482-7000
Mailing Address - Fax:
Practice Address - Street 1:7281 E EARLL DR STE 1
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7245
Practice Address - Country:US
Practice Address - Phone:480-634-4013
Practice Address - Fax:480-634-4020
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32395122300000X
AZD0116921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32395OtherTEXAS STATE BOARD OF DENTAL EXAMINERS