Provider Demographics
NPI:1770642506
Name:NGUYEN, TINA T (DDS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3026
Mailing Address - Country:US
Mailing Address - Phone:408-298-1600
Mailing Address - Fax:
Practice Address - Street 1:1089 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3026
Practice Address - Country:US
Practice Address - Phone:408-298-1600
Practice Address - Fax:408-298-1602
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice