Provider Demographics
NPI:1952327652
Name:NGUYEN, TRACY TRUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:TRUC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13920 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4037
Mailing Address - Country:US
Mailing Address - Phone:714-893-2100
Mailing Address - Fax:714-589-2525
Practice Address - Street 1:13920 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4037
Practice Address - Country:US
Practice Address - Phone:714-893-2100
Practice Address - Fax:714-589-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476471223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1632532OtherUNITED CONCORDIA ID
CAG93073-01OtherDENTI-CAL
CA1632532OtherUNITED CONCORDIA ID