Provider Demographics
NPI:1790890176
Name:NGUYEN, NGOC DUNG THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGOC DUNG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 E FREMONT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3650
Mailing Address - Country:US
Mailing Address - Phone:408-738-8840
Mailing Address - Fax:408-738-8846
Practice Address - Street 1:826 E FREMONT AVE STE D
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3650
Practice Address - Country:US
Practice Address - Phone:408-738-8840
Practice Address - Fax:408-738-8846
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82961223G0001X
CA578961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4101227OtherBCBS
01385805OtherUNITED CONCORDIA