Provider Demographics
NPI:1407913585
Name:NGUYEN, KEVIN THAI (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 NOBLEWOOD PLZ
Mailing Address - Street 2:#207
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1443
Mailing Address - Country:US
Mailing Address - Phone:703-878-9000
Mailing Address - Fax:703-878-9999
Practice Address - Street 1:14130 NOBLEWOOD PLZ
Practice Address - Street 2:#207-208
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1443
Practice Address - Country:US
Practice Address - Phone:703-878-9000
Practice Address - Fax:703-878-9999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4014102701223G0001X
VA04014102701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice