Provider Demographics
NPI:1891176723
Name:NGUYEN, PHUONG CAM (DDS)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:CAM
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 1:2100 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1604
Mailing Address - Country:US
Mailing Address - Phone:402-613-9916
Mailing Address - Fax:
Practice Address - Street 1:2100 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1604
Practice Address - Country:US
Practice Address - Phone:712-239-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-092041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice