Provider Demographics
NPI:1558481200
Name:NGUYEN, QUANG T (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUANG
Middle Name:T
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 1:14536 BROOKHURST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5787
Mailing Address - Country:US
Mailing Address - Phone:714-531-6637
Mailing Address - Fax:
Practice Address - Street 1:14536 BROOKHURST ST STE 203
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5787
Practice Address - Country:US
Practice Address - Phone:714-531-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB32153-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32153-01OtherDENTI-CAL