Provider Demographics
NPI:1336363993
Name:PORTNOY, GIANH NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIANH
Middle Name:NGUYEN
Last Name:PORTNOY
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 1:2345 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2016
Mailing Address - Country:US
Mailing Address - Phone:517-381-5043
Mailing Address - Fax:
Practice Address - Street 1:1738 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1811
Practice Address - Country:US
Practice Address - Phone:517-349-3266
Practice Address - Fax:517-381-2457
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316952732OtherPORTNOY AND TU DDS PC