Provider Demographics
NPI:1790467066
Name:NGUYEN, MAILOAN TUAN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MAILOAN
Middle Name:TUAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GIRARD AVE UNIT 402
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1168
Mailing Address - Country:US
Mailing Address - Phone:857-615-5931
Mailing Address - Fax:
Practice Address - Street 1:1173 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1632
Practice Address - Country:US
Practice Address - Phone:401-841-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1398473124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist