Provider Demographics
NPI:1417483124
Name:CLARA NGUYEN DDS, INC
Entity Type:Organization
Organization Name:CLARA NGUYEN DDS, INC
Other - Org Name:COAST DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-995-9700
Mailing Address - Street 1:12802 VALLEY VIEW ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2511
Mailing Address - Country:US
Mailing Address - Phone:714-995-9700
Mailing Address - Fax:714-995-2416
Practice Address - Street 1:12802 VALLEY VIEW ST.
Practice Address - Street 2:STE. 2
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-995-9700
Practice Address - Fax:714-995-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty