Provider Demographics
NPI:1902025919
Name:NGUYEN, DOUGLAS DUC TIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DUC TIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 BOLSA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5949
Mailing Address - Country:US
Mailing Address - Phone:714-839-9800
Mailing Address - Fax:714-839-9894
Practice Address - Street 1:9600 BOLSA AVE STE E
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5949
Practice Address - Country:US
Practice Address - Phone:714-839-9800
Practice Address - Fax:714-839-9894
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD40970OtherDENTI-CAL OLD RENDERING PROVIDER NUMBER