Provider Demographics
NPI:1255409694
Name:NGUYEN, MINH DUC (DDS)
Entity type:Individual
Prefix:DR
First Name:MINH
Middle Name:DUC
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 1:3273 TURLOCK DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12880 BEACH BLVD
Practice Address - Street 2:STUITE AA
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680
Practice Address - Country:US
Practice Address - Phone:714-890-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist