Provider Demographics
NPI:1801381660
Name:NGUYEN, NATALIE HOANG (DMD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 W MARCO POLO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7363
Mailing Address - Country:US
Mailing Address - Phone:714-609-3962
Mailing Address - Fax:
Practice Address - Street 1:742 E GLENDALE AVE STE 118
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5352
Practice Address - Country:US
Practice Address - Phone:602-491-0887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0100811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice