Provider Demographics
NPI:1942898697
Name:MARK NGUYEN DDS INC
Entity Type:Organization
Organization Name:MARK NGUYEN DDS INC
Other - Org Name:LITTLE HEALTHY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-907-4842
Mailing Address - Street 1:1202 BRISTOL ST STE 140
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8606
Mailing Address - Country:US
Mailing Address - Phone:714-907-4842
Mailing Address - Fax:
Practice Address - Street 1:1202 BRISTOL ST STE 140
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8606
Practice Address - Country:US
Practice Address - Phone:714-907-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty