Provider Demographics
NPI:1437336484
Name:NGUYEN, MICHAEL THUC (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CAMPUS DR STE 304
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4930
Mailing Address - Country:US
Mailing Address - Phone:650-756-1900
Mailing Address - Fax:650-756-9287
Practice Address - Street 1:901 CAMPUS DR STE 304
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-756-1900
Practice Address - Fax:650-756-9287
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist