Provider Demographics
NPI:1609957067
Name:NGUYEN, KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 PENNSYLVANIA AVE
Mailing Address - Street 2:LL
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1332
Mailing Address - Country:US
Mailing Address - Phone:302-482-4444
Mailing Address - Fax:302-482-4446
Practice Address - Street 1:2323 PENNSYLVANIA AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-426-0526
Practice Address - Fax:302-426-0511
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice