Provider Demographics
NPI:1407881170
Name:NGUYEN, TUNG T (DMD)
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:T
Last Name:NGUYEN
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 1:1112 E CONE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4546
Mailing Address - Country:US
Mailing Address - Phone:336-510-0456
Mailing Address - Fax:336-510-0457
Practice Address - Street 1:1112 E CONE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4546
Practice Address - Country:US
Practice Address - Phone:336-510-0456
Practice Address - Fax:336-510-0457
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72271223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2373923210Medicaid
NC1482957OtherUNITED CONCORDIA
NC8990154Medicaid
NC90154OtherBLUE CROSS BLUE SHIELD
NC98714-1OtherUNITED HEALTH CARE
NC90154OtherNC STATE HEALTH CHOICE