Provider Demographics
NPI:1649424532
Name:JASON NGUYEN'S DENTAL CORPORATION
Entity Type:Organization
Organization Name:JASON NGUYEN'S DENTAL CORPORATION
Other - Org Name:CROWN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KHOA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-827-1100
Mailing Address - Street 1:6300 WHITE LN STE C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-8776
Mailing Address - Country:US
Mailing Address - Phone:661-827-1100
Mailing Address - Fax:661-827-1117
Practice Address - Street 1:6300 WHITE LN STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-8776
Practice Address - Country:US
Practice Address - Phone:661-827-1100
Practice Address - Fax:661-827-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty