Provider Demographics
NPI:1740404490
Name:NGUYEN, DUC-THANH HY (DMD)
Entity Type:Individual
Prefix:
First Name:DUC-THANH
Middle Name:HY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33560 BLUE WATER WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-7838
Mailing Address - Country:US
Mailing Address - Phone:951-302-2116
Mailing Address - Fax:951-302-2192
Practice Address - Street 1:31213 HWY 79 S. SUITE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-302-2116
Practice Address - Fax:951-302-2192
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice