Provider Demographics
NPI:1598963373
Name:NGUYEN, THACHTU LE (DDS)
Entity Type:Individual
Prefix:
First Name:THACHTU
Middle Name:LE
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 1:1111 STORY RD
Mailing Address - Street 2:STE #1037
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122
Mailing Address - Country:US
Mailing Address - Phone:408-999-0480
Mailing Address - Fax:408-288-8212
Practice Address - Street 1:1111 STORY RD
Practice Address - Street 2:STE #1037
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-999-0480
Practice Address - Fax:408-288-8212
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice