Provider Demographics
NPI:1902220718
Name:KENNETH T NGUYEN DDS INC
Entity Type:Organization
Organization Name:KENNETH T NGUYEN DDS INC
Other - Org Name:CAVITY CATCHER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-695-5678
Mailing Address - Street 1:42210 LYNDIE LN STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3603
Mailing Address - Country:US
Mailing Address - Phone:951-695-5678
Mailing Address - Fax:866-309-1773
Practice Address - Street 1:42210 LYNDIE LN STE B
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3603
Practice Address - Country:US
Practice Address - Phone:951-695-5678
Practice Address - Fax:866-309-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty