Provider Demographics
NPI:1467887943
Name:NGUYEN, DUNG LY SR (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DUNG
Middle Name:LY
Last Name:NGUYEN
Suffix:SR
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 EUCLID AVE
Mailing Address - Street 2:#A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115
Mailing Address - Country:US
Mailing Address - Phone:619-281-6777
Mailing Address - Fax:619-281-1987
Practice Address - Street 1:4310 EUCLID AVE
Practice Address - Street 2:#A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115
Practice Address - Country:US
Practice Address - Phone:619-281-6777
Practice Address - Fax:619-281-1987
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist