Provider Demographics
NPI:1790449395
Name:VAN T. NGUYEN DMD CORP
Entity Type:Organization
Organization Name:VAN T. NGUYEN DMD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:THUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-528-8292
Mailing Address - Street 1:1251 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1718
Mailing Address - Country:US
Mailing Address - Phone:714-528-8292
Mailing Address - Fax:714-528-8373
Practice Address - Street 1:1251 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1718
Practice Address - Country:US
Practice Address - Phone:714-528-8292
Practice Address - Fax:714-528-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental