Provider Demographics
NPI:1679986392
Name:NGUYEN, DANIEL VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VAN
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 1:1120 SALISBURY CT
Mailing Address - Street 2:APT 11
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1787
Mailing Address - Country:US
Mailing Address - Phone:402-580-2674
Mailing Address - Fax:
Practice Address - Street 1:7933 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2468
Practice Address - Country:US
Practice Address - Phone:913-213-6973
Practice Address - Fax:913-213-6972
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist