Provider Demographics
NPI:1518051028
Name:NGUYEN, ANTHONY S (DMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 PARKMONT LN SW STE D
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1181
Mailing Address - Country:US
Mailing Address - Phone:360-810-6101
Mailing Address - Fax:253-201-9877
Practice Address - Street 1:2639 PARKMONT LN SW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1181
Practice Address - Country:US
Practice Address - Phone:360-810-6101
Practice Address - Fax:253-201-9877
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE94431223G0001X
WA94431223G0001X
WADE000094431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice