Provider Demographics
NPI:1457473084
Name:THI M NGUYEN A PROFESSIONAL DENTAL CO
Entity Type:Organization
Organization Name:THI M NGUYEN A PROFESSIONAL DENTAL CO
Other - Org Name:MAI THI T NGUYEN DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MAI THI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-638-5513
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:9746 WESTMINSTER AVE #C
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-638-5513
Mailing Address - Fax:714-638-2112
Practice Address - Street 1:9746 WESTMINSTER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844
Practice Address - Country:US
Practice Address - Phone:714-638-5513
Practice Address - Fax:714-638-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB339621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty