Provider Demographics
NPI:1245958149
Name:NGUYEN, PATRICK LONGDUY (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:LONGDUY
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 1:815 S FLOWER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-5385
Mailing Address - Country:US
Mailing Address - Phone:310-256-6361
Mailing Address - Fax:
Practice Address - Street 1:12125 HIGHWAY 6 STE D
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8844
Practice Address - Country:US
Practice Address - Phone:281-431-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice