Provider Demographics
NPI:1508394982
Name:THOMAS J NGUYEN DDS
Entity Type:Organization
Organization Name:THOMAS J NGUYEN DDS
Other - Org Name:THOMAS J NGUYEN DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-320-8435
Mailing Address - Street 1:3420 COACH LN STE 6
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8406
Mailing Address - Country:US
Mailing Address - Phone:530-677-0203
Mailing Address - Fax:530-677-6215
Practice Address - Street 1:3420 COACH LN STE 6
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8406
Practice Address - Country:US
Practice Address - Phone:530-677-0203
Practice Address - Fax:530-677-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty