Provider Demographics
NPI:1689828873
Name:NGUYEN, MINH, DDS A DENTAL CORP
Entity Type:Organization
Organization Name:NGUYEN, MINH, DDS A DENTAL CORP
Other - Org Name:BEACH GROVE DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-890-1122
Mailing Address - Street 1:12880 BEACH BLVD
Mailing Address - Street 2:SUITE AA
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680
Mailing Address - Country:US
Mailing Address - Phone:714-890-1122
Mailing Address - Fax:714-896-9512
Practice Address - Street 1:12880 BEACH BLVD
Practice Address - Street 2:SUITE AA
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680
Practice Address - Country:US
Practice Address - Phone:714-890-1122
Practice Address - Fax:714-896-9512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NGUYEN, MINH, DDS A DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45505-01OtherMEDI - CAL