Provider Demographics
NPI:1639593817
Name:NGUYEN V. NGUYEN, DMD, PA
Entity Type:Organization
Organization Name:NGUYEN V. NGUYEN, DMD, PA
Other - Org Name:MAGNOLIA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-493-0975
Mailing Address - Street 1:2640 WINDSORGATE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7957
Mailing Address - Country:US
Mailing Address - Phone:407-493-0977
Mailing Address - Fax:
Practice Address - Street 1:12014 E COLONIAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4750
Practice Address - Country:US
Practice Address - Phone:407-493-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18897261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental