Provider Demographics
NPI:1891082657
Name:NGUYEN, KHANH P (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KHANI
Other - Middle Name:P
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2224 ROUTE 37 E
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6000
Mailing Address - Country:US
Mailing Address - Phone:732-270-5566
Mailing Address - Fax:
Practice Address - Street 1:2224 ROUTE 37 E
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6000
Practice Address - Country:US
Practice Address - Phone:732-270-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387921223G0001X
NJ22DI02532000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice