Provider Demographics
NPI:1952638223
Name:NGUYEN, TRUYEN DUC (DDS)
Entity Type:Individual
Prefix:
First Name:TRUYEN
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:SUITE #119
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-743-8133
Mailing Address - Fax:918-743-3296
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:SUITE #119
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-743-8133
Practice Address - Fax:918-743-3296
Is Sole Proprietor?:No
Enumeration Date:2009-11-07
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist