Provider Demographics
NPI:1508198615
Name:NGUYEN & DO DENTAL CORP
Entity Type:Organization
Organization Name:NGUYEN & DO DENTAL CORP
Other - Org Name:KIDS & BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:CONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-943-4488
Mailing Address - Street 1:15775 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2510
Mailing Address - Country:US
Mailing Address - Phone:562-943-4488
Mailing Address - Fax:562-943-4422
Practice Address - Street 1:15775 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2510
Practice Address - Country:US
Practice Address - Phone:562-943-4488
Practice Address - Fax:562-943-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46308305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization