Provider Demographics
NPI:1639364490
Name:NGUYEN, DONNA TRANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:TRANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 EAST ST LOUIS STREET
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263
Mailing Address - Country:US
Mailing Address - Phone:618-327-4315
Mailing Address - Fax:618-327-4480
Practice Address - Street 1:520 EAST ST LOUIS STREET
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263
Practice Address - Country:US
Practice Address - Phone:618-327-4315
Practice Address - Fax:618-327-4480
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist