Provider Demographics
NPI:1790816064
Name:QUYNH A. TRAN-NGUYEN, D.M.D, DENTAL CORPORATION
Entity Type:Organization
Organization Name:QUYNH A. TRAN-NGUYEN, D.M.D, DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYNH
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:TRAN-NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-498-8856
Mailing Address - Street 1:1000 NEWBURY RD
Mailing Address - Street 2:SUITE #138
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6435
Mailing Address - Country:US
Mailing Address - Phone:805-498-8856
Mailing Address - Fax:805-498-8867
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE #138
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-498-8856
Practice Address - Fax:805-498-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty