Provider Demographics
NPI:1871683789
Name:NGUYEN, NGHIA VAN (DDS)
Entity Type:Individual
Prefix:
First Name:NGHIA
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NGHIA
Other - Middle Name:PETER
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3546 GRAVOIS AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118
Mailing Address - Country:US
Mailing Address - Phone:314-773-3666
Mailing Address - Fax:
Practice Address - Street 1:3546 GRAVOIS AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118
Practice Address - Country:US
Practice Address - Phone:314-773-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice