Provider Demographics
NPI:1205925302
Name:NGUYEN, TINA D (DDS)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CATTANO AVE
Mailing Address - Street 2:APT 418
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6829
Mailing Address - Country:US
Mailing Address - Phone:917-816-7612
Mailing Address - Fax:
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:SUITE B1
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:917-816-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022188001223P0221X
NY048738-11223P0221X
NJ22DI022188021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry