Provider Demographics
NPI:1942211933
Name:NGUYEN, DIANE HAO (DDS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:HAO
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 1:969 WINDY HILL ROAD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-431-9578
Mailing Address - Fax:770-438-2919
Practice Address - Street 1:969 WINDY HILL ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-431-9578
Practice Address - Fax:770-438-2919
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100489OtherAVESIS GA MEDICAL DENTAL
GA000909235AMedicaid
GA9180389OtherDORAL
GA000909235AMedicaid