Provider Demographics
NPI:1609518786
Name:NGUYEN, BRYAN LONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LONG
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 1:6948 RED CLAY FRG
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6368
Mailing Address - Country:US
Mailing Address - Phone:405-314-9501
Mailing Address - Fax:
Practice Address - Street 1:192 HALPINE RD STE A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-7645
Practice Address - Country:US
Practice Address - Phone:405-314-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist