Provider Demographics
NPI:1578579835
Name:CHAULONG T NGUYEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHAULONG T NGUYEN DENTAL CORPORATION
Other - Org Name:MENLO PARK DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAULONG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-838-0260
Mailing Address - Street 1:724 OAK GROVE AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-838-0260
Mailing Address - Fax:650-838-0495
Practice Address - Street 1:724 OAK GROVE AVE
Practice Address - Street 2:STE 120
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-838-0260
Practice Address - Fax:650-838-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty