Provider Demographics
NPI:1417042177
Name:HOANG THANH NGUYEN, DDS, INC
Entity Type:Organization
Organization Name:HOANG THANH NGUYEN, DDS, INC
Other - Org Name:ABC DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-671-8535
Mailing Address - Street 1:4233 W CENTURY BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-3646
Mailing Address - Country:US
Mailing Address - Phone:310-671-8535
Mailing Address - Fax:
Practice Address - Street 1:4233 W CENTURY BLVD STE 4
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-3646
Practice Address - Country:US
Practice Address - Phone:310-671-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty