Provider Demographics
NPI:1992849020
Name:NGUYEN, HIEP THANH (DDS)
Entity Type:Individual
Prefix:
First Name:HIEP
Middle Name:THANH
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 1:28302 BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6401
Mailing Address - Country:US
Mailing Address - Phone:951-522-6630
Mailing Address - Fax:
Practice Address - Street 1:2409 S VINEYARD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6401
Practice Address - Country:US
Practice Address - Phone:909-923-9557
Practice Address - Fax:909-923-9946
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice