Provider Demographics
NPI:1508357161
Name:NGUYEN, DANH CONG (DDS)
Entity Type:Individual
Prefix:
First Name:DANH
Middle Name:CONG
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 1:5604 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4428
Mailing Address - Country:US
Mailing Address - Phone:504-920-3383
Mailing Address - Fax:
Practice Address - Street 1:2996 BIENVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4303
Practice Address - Country:US
Practice Address - Phone:504-605-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6859122300000X
MS4076-191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist