Provider Demographics
NPI:1417055864
Name:NGUYEN, THIEN TRANG THI (DDS)
Entity Type:Individual
Prefix:
First Name:THIEN TRANG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TRANG
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14520 NEWPORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1019
Mailing Address - Country:US
Mailing Address - Phone:714-544-9800
Mailing Address - Fax:714-544-1660
Practice Address - Street 1:14520 NEWPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1019
Practice Address - Country:US
Practice Address - Phone:714-544-9800
Practice Address - Fax:714-544-1660
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice