Provider Demographics
NPI:1417306440
Name:TIMOTHY THOAI NGUYEN D.D.S., INC.
Entity Type:Organization
Organization Name:TIMOTHY THOAI NGUYEN D.D.S., INC.
Other - Org Name:ORAL SURGERY & IMPLANT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:THOAI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-946-6666
Mailing Address - Street 1:991 MONTAGUE EXPY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6809
Mailing Address - Country:US
Mailing Address - Phone:408-946-6666
Mailing Address - Fax:408-935-8805
Practice Address - Street 1:991 MONTAGUE EXPY
Practice Address - Street 2:SUITE 102
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6809
Practice Address - Country:US
Practice Address - Phone:408-946-6666
Practice Address - Fax:408-935-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty