Provider Demographics
NPI:1407875925
Name:NGUYEN, THUTAM THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:THUTAM
Middle Name:THI
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 1:259 MERIDIAN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2905
Mailing Address - Country:US
Mailing Address - Phone:408-293-8725
Mailing Address - Fax:408-293-9060
Practice Address - Street 1:259 MERIDIAN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2905
Practice Address - Country:US
Practice Address - Phone:408-293-8725
Practice Address - Fax:408-293-9060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice