Provider Demographics
NPI:1730668310
Name:TIN DUC NGUYEN DMD AND LAN THI NGOC NGUYEN DMD, PLLC
Entity Type:Organization
Organization Name:TIN DUC NGUYEN DMD AND LAN THI NGOC NGUYEN DMD, PLLC
Other - Org Name:FOREVER SMILES FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-591-4267
Mailing Address - Street 1:4528 W 26TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1863
Mailing Address - Country:US
Mailing Address - Phone:509-591-4267
Mailing Address - Fax:509-628-5204
Practice Address - Street 1:4528 W 26TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1863
Practice Address - Country:US
Practice Address - Phone:509-591-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605122431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty