Provider Demographics
NPI:1558436204
Name:NGUYEN, ELIZABETH B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:NGUYEN
Suffix:
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 1:2480 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:REDWOOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-216-8488
Mailing Address - Fax:650-216-7488
Practice Address - Street 1:2480 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-216-8488
Practice Address - Fax:650-216-7488
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist