Provider Demographics
NPI:1447380282
Name:NGUYEN, SON T (DDS)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 W POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3723
Mailing Address - Country:US
Mailing Address - Phone:714-943-5405
Mailing Address - Fax:
Practice Address - Street 1:1473 N DYSART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1548
Practice Address - Country:US
Practice Address - Phone:623-925-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist