Provider Demographics
NPI:1790258556
Name:NGUYEN LY NGUY DENTAL CORP
Entity Type:Organization
Organization Name:NGUYEN LY NGUY DENTAL CORP
Other - Org Name:WEST CORONA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-340-0200
Mailing Address - Street 1:4264 GREEN RIVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880
Mailing Address - Country:US
Mailing Address - Phone:951-340-0200
Mailing Address - Fax:951-278-9858
Practice Address - Street 1:4264 GREEN RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880
Practice Address - Country:US
Practice Address - Phone:951-340-0200
Practice Address - Fax:951-278-9858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CORONA DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty