Provider Demographics
NPI:1639317795
Name:DAT QUOC NGUYEN D.D.S., INC.
Entity Type:Organization
Organization Name:DAT QUOC NGUYEN D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-280-6733
Mailing Address - Street 1:11812 MAC DUFF ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2208
Mailing Address - Country:US
Mailing Address - Phone:626-280-6733
Mailing Address - Fax:714-539-9224
Practice Address - Street 1:9008 GARVEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3360
Practice Address - Country:US
Practice Address - Phone:626-280-6733
Practice Address - Fax:626-280-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty