Provider Demographics
NPI:1407329774
Name:MANUEL NGUYEN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MANUEL NGUYEN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-706-5751
Mailing Address - Street 1:866 SEVEN HILLS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4375
Mailing Address - Country:US
Mailing Address - Phone:909-706-5751
Mailing Address - Fax:
Practice Address - Street 1:866 SEVEN HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4375
Practice Address - Country:US
Practice Address - Phone:909-706-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty