Provider Demographics
NPI:1922737139
Name:NGUYEN, DUY KHANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUY
Middle Name:KHANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LATO
Other - Middle Name:KHANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1801 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2186
Mailing Address - Country:US
Mailing Address - Phone:414-719-2460
Mailing Address - Fax:
Practice Address - Street 1:6015 W FOREST HOME AVE STE 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1992
Practice Address - Country:US
Practice Address - Phone:414-892-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000052-12122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist