Provider Demographics
NPI:1205316361
Name:NGUYEN, NAM DUC-HAI (DDS)
Entity type:Individual
Prefix:DR
First Name:NAM
Middle Name:DUC-HAI
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 1:8933 MARKET PL STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4909
Mailing Address - Country:US
Mailing Address - Phone:425-334-5085
Mailing Address - Fax:
Practice Address - Street 1:8933 MARKET PL STE A
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-4909
Practice Address - Country:US
Practice Address - Phone:425-334-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60882843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist