Provider Demographics
NPI:1790762995
Name:NGUYEN, THUC KIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:THUC
Middle Name:KIEN
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 1:6260 GLEN OAKS LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4197
Mailing Address - Country:US
Mailing Address - Phone:404-256-5547
Mailing Address - Fax:
Practice Address - Street 1:4719 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5503
Practice Address - Country:US
Practice Address - Phone:770-671-1311
Practice Address - Fax:770-671-1389
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist