Provider Demographics
NPI:1962853671
Name:NGUYEN, MINH (DMD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:
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 1:75 STATION LNDG
Mailing Address - Street 2:UNIT 710
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 STATION LNDG
Practice Address - Street 2:UNIT 710
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5127
Practice Address - Country:US
Practice Address - Phone:408-744-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist