Provider Demographics
NPI:1689795593
Name:D NGUYEN, DDS, PS
Entity Type:Organization
Organization Name:D NGUYEN, DDS, PS
Other - Org Name:PACIFIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DZON
Authorized Official - Middle Name:MANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:435-557-6453
Mailing Address - Street 1:670 NW GILMAN BLVD STE B3
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2444
Mailing Address - Country:US
Mailing Address - Phone:425-557-6453
Mailing Address - Fax:425-391-5556
Practice Address - Street 1:670 NW GILMAN BLVD STE B3
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2444
Practice Address - Country:US
Practice Address - Phone:425-557-6453
Practice Address - Fax:425-391-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087731223G0001X
WADE000081721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty