Provider Demographics
NPI:1659448116
Name:NGUYEN, RICHARD T (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9741 BOLSA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6683
Mailing Address - Country:US
Mailing Address - Phone:714-775-8434
Mailing Address - Fax:714-775-1241
Practice Address - Street 1:9741 BOLSA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6683
Practice Address - Country:US
Practice Address - Phone:714-775-8434
Practice Address - Fax:714-775-1241
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52659OtherPROVIDER NUMBER/ LICENSE NUMBER