Provider Demographics
NPI:1942860226
Name:NGUYEN, THAO THANH (DMD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 48TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1700
Mailing Address - Country:US
Mailing Address - Phone:941-753-1432
Mailing Address - Fax:941-757-3532
Practice Address - Street 1:2620 48TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1700
Practice Address - Country:US
Practice Address - Phone:941-753-1432
Practice Address - Fax:941-757-3532
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN242621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice