Provider Demographics
NPI:1639243256
Name:DELIMA & NGUYEN, D.M.D.
Entity Type:Organization
Organization Name:DELIMA & NGUYEN, D.M.D.
Other - Org Name:METROWEST DENTAL ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-429-5500
Mailing Address - Street 1:71 CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746
Mailing Address - Country:US
Mailing Address - Phone:508-429-5500
Mailing Address - Fax:508-429-3413
Practice Address - Street 1:71 CHARLES STREET
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746
Practice Address - Country:US
Practice Address - Phone:508-429-5500
Practice Address - Fax:508-429-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200321223G0001X
MA191901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty