Provider Demographics
NPI:1619006400
Name:NGUYEN, ELIZABETH HANH-DUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HANH-DUNG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 PORTIFINO ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8406
Mailing Address - Country:US
Mailing Address - Phone:209-825-6267
Mailing Address - Fax:
Practice Address - Street 1:955 BLUEBELL DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-5319
Practice Address - Country:US
Practice Address - Phone:925-961-1101
Practice Address - Fax:925-961-1126
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice