Provider Demographics
NPI:1619173788
Name:NGUYEN, TIEU LIEN (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:TIEU LIEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 HARVARD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2829
Mailing Address - Country:US
Mailing Address - Phone:617-783-2468
Mailing Address - Fax:
Practice Address - Street 1:196 HARVARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2829
Practice Address - Country:US
Practice Address - Phone:617-783-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics