Provider Demographics
NPI:1689750887
Name:NGUYEN, THUONG-TRI DINH (DDS)
Entity Type:Individual
Prefix:MR
First Name:THUONG-TRI
Middle Name:DINH
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 1:4814 MONTICELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814
Mailing Address - Country:US
Mailing Address - Phone:225-275-4665
Mailing Address - Fax:225-274-8906
Practice Address - Street 1:4814 MONTICELLO BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814
Practice Address - Country:US
Practice Address - Phone:225-275-4665
Practice Address - Fax:225-274-8906
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1854204Medicaid