Provider Demographics
NPI:1699002659
Name:JACQUELINE B. NGUYEN, D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JACQUELINE B. NGUYEN, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:SOUTH VALLEY DENTISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-578-8848
Mailing Address - Street 1:6950 SANTA TERESA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1300
Mailing Address - Country:US
Mailing Address - Phone:408-578-8848
Mailing Address - Fax:408-578-8878
Practice Address - Street 1:6950 SANTA TERESA BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1300
Practice Address - Country:US
Practice Address - Phone:408-578-8848
Practice Address - Fax:408-578-8878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACQUELINE B. NGUYEN, D.D.S., A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty