Provider Demographics
NPI:1467676312
Name:NGUYEN, THANH QUOC (DDS)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:QUOC
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 1:319 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-4108
Mailing Address - Country:US
Mailing Address - Phone:714-569-1100
Mailing Address - Fax:714-547-1235
Practice Address - Street 1:319 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-4108
Practice Address - Country:US
Practice Address - Phone:714-569-1100
Practice Address - Fax:714-547-1235
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice