Provider Demographics
NPI:1629297403
Name:NGUYEN, LOAN MAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOAN
Middle Name:MAI
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 1:1816 TULLY RD
Mailing Address - Street 2:SUITE 243
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4405
Mailing Address - Country:US
Mailing Address - Phone:408-270-3333
Mailing Address - Fax:408-223-8899
Practice Address - Street 1:1816 TULLY RD
Practice Address - Street 2:SUITE 243
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4405
Practice Address - Country:US
Practice Address - Phone:408-270-3333
Practice Address - Fax:408-223-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice