Provider Demographics
NPI:1942487582
Name:DR NGOC H NGUYEN D D S INC
Entity Type:Organization
Organization Name:DR NGOC H NGUYEN D D S INC
Other - Org Name:WELLNESS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-691-0685
Mailing Address - Street 1:9390 BIG HORN BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7978
Mailing Address - Country:US
Mailing Address - Phone:916-691-0685
Mailing Address - Fax:916-691-0687
Practice Address - Street 1:9390 BIG HORN BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7978
Practice Address - Country:US
Practice Address - Phone:916-691-0685
Practice Address - Fax:916-691-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB48837-02OtherDDSGP-BILLING PROVIDER ID
CA101467OtherDHA PRACTICE ID