Provider Demographics
NPI:1932485299
Name:NGUYEN, ANNIE VAN ANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:VAN ANH
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 1:3105 MONROE WAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2826
Mailing Address - Country:US
Mailing Address - Phone:949-878-0433
Mailing Address - Fax:
Practice Address - Street 1:3105 MONROE WAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2826
Practice Address - Country:US
Practice Address - Phone:949-878-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice