Provider Demographics
NPI:1558413567
Name:NGUYEN, THANH KIM SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:KIM
Last Name:NGUYEN
Suffix:SR
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WINTERSWEET CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3230
Mailing Address - Country:US
Mailing Address - Phone:301-924-0564
Mailing Address - Fax:
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 514
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-946-8444
Practice Address - Fax:301-946-8447
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice