Provider Demographics
NPI:1295518991
Name:NGUYEN, MARY XUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:XUAN
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 1:8705 CELERY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1804
Mailing Address - Country:US
Mailing Address - Phone:916-230-2121
Mailing Address - Fax:
Practice Address - Street 1:9640 BRUCEVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5937
Practice Address - Country:US
Practice Address - Phone:916-684-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1090991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice