Provider Demographics
NPI:1841421567
Name:NGO, TIEN Q (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:Q
Last Name:NGO
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 1:28 S FREDERICK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2395
Mailing Address - Country:US
Mailing Address - Phone:240-472-8029
Mailing Address - Fax:301-330-6235
Practice Address - Street 1:28 S FREDERICK AVE STE 101
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2395
Practice Address - Country:US
Practice Address - Phone:240-472-8029
Practice Address - Fax:301-330-6235
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDMD143881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program