Provider Demographics
NPI:1184744237
Name:BOITRAN CAO NGUYEN DDS INC
Entity type:Organization
Organization Name:BOITRAN CAO NGUYEN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOITRAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-448-5773
Mailing Address - Street 1:9560 CUYAMACA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2689
Mailing Address - Country:US
Mailing Address - Phone:619-448-5773
Mailing Address - Fax:618-448-5770
Practice Address - Street 1:9560 CUYAMACA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2689
Practice Address - Country:US
Practice Address - Phone:619-448-5773
Practice Address - Fax:619-448-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty