Provider Demographics
NPI:1932478542
Name:FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTI/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUAN-ANH
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-320-9004
Mailing Address - Street 1:5170 E. GLENN STREET
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-320-9004
Mailing Address - Fax:520-325-3726
Practice Address - Street 1:5170 E GLENN ST
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1396
Practice Address - Country:US
Practice Address - Phone:520-320-9004
Practice Address - Fax:520-325-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty