Provider Demographics
NPI:1871633594
Name:NGUYEN, THUY-MAI (DDS)
Entity Type:Individual
Prefix:
First Name:THUY-MAI
Middle Name:
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 1:761 CHANTECLER DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4915
Mailing Address - Country:US
Mailing Address - Phone:510-249-9308
Mailing Address - Fax:
Practice Address - Street 1:1418 DEMPSEY RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6977
Practice Address - Country:US
Practice Address - Phone:408-263-6646
Practice Address - Fax:408-263-6645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36809-01Medicaid
CAG98165-01OtherDELTAHLTHYFAMILYPRVDR ID
CA36809OtherDENTAL BOARD LICENSE