Provider Demographics
NPI:1487635074
Name:NGUYEN, ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
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 1:33054 STATE ROUTE 26
Mailing Address - Street 2:A HAPPY SMILE DENTAL OFFICE, PC
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619
Mailing Address - Country:US
Mailing Address - Phone:315-493-9393
Mailing Address - Fax:315-493-9394
Practice Address - Street 1:33054 STATE ROUTE 26
Practice Address - Street 2:A HAPPY SMILE DENTAL OFFICE, PC
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-9393
Practice Address - Fax:315-493-9394
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49615122300000X
NY052642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN