Provider Demographics
NPI:1942677752
Name:THANH NGOC NGUYEN, DMD, INC
Entity Type:Organization
Organization Name:THANH NGOC NGUYEN, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:THANH HA
Authorized Official - Last Name:BUI-TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-531-5175
Mailing Address - Street 1:15355 BROOKHURST ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7077
Mailing Address - Country:US
Mailing Address - Phone:714-531-5175
Mailing Address - Fax:
Practice Address - Street 1:15355 BROOKHURST ST
Practice Address - Street 2:SUITE101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7077
Practice Address - Country:US
Practice Address - Phone:714-531-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29401261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental