Provider Demographics
NPI:1336556372
Name:NGUYEN, LAN THI NGOC (DMD)
Entity Type:Individual
Prefix:
First Name:LAN THI
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 W 26TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1863
Mailing Address - Country:US
Mailing Address - Phone:509-591-4267
Mailing Address - Fax:509-628-5204
Practice Address - Street 1:4528 W 26TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1863
Practice Address - Country:US
Practice Address - Phone:509-591-4267
Practice Address - Fax:509-628-5204
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30296122300000X
WADE60559889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist