Provider Demographics
NPI:1942311667
Name:DO, NGUYEN (DDS)
Entity Type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11915 BEACH BLVD
Mailing Address - Street 2:STE. 115
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6704
Mailing Address - Country:US
Mailing Address - Phone:904-620-7300
Mailing Address - Fax:904-620-7343
Practice Address - Street 1:11915 BEACH BLVD
Practice Address - Street 2:STE. 115
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6704
Practice Address - Country:US
Practice Address - Phone:904-620-7300
Practice Address - Fax:904-620-7343
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172251223G0001X
FL172251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice