Provider Demographics
NPI:1639298425
Name:NGUYEN, HA HEATHER (DDS)
Entity Type:Individual
Prefix:
First Name:HA
Middle Name:HEATHER
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 1:2121 SHIANGZONE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1468
Mailing Address - Country:US
Mailing Address - Phone:408-264-7630
Mailing Address - Fax:
Practice Address - Street 1:1705 BRANHAM LN
Practice Address - Street 2:B4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-5222
Practice Address - Country:US
Practice Address - Phone:408-264-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice