Provider Demographics
NPI:1871503888
Name:NGUYEN, BICH-LOAN FLORENCE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:BICH-LOAN
Middle Name:FLORENCE
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 1:21665 SUPERIOR LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1928
Mailing Address - Country:US
Mailing Address - Phone:949-637-4673
Mailing Address - Fax:
Practice Address - Street 1:5127 W EDINGER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1969
Practice Address - Country:US
Practice Address - Phone:714-775-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB35528-01OtherMEDI-CAL