Provider Demographics
NPI:1841411394
Name:NGUYEN, TRUNG THANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4607
Mailing Address - Country:US
Mailing Address - Phone:616-530-9510
Mailing Address - Fax:616-530-9750
Practice Address - Street 1:1515 44TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-4607
Practice Address - Country:US
Practice Address - Phone:616-530-9510
Practice Address - Fax:616-530-9750
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist