Provider Demographics
NPI:1356361711
Name:NGUYEN, MONIQUE H (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:H
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 1:8492 RICHMOND HWY
Mailing Address - Street 2:104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-8492
Mailing Address - Country:US
Mailing Address - Phone:703-780-3482
Mailing Address - Fax:703-799-9577
Practice Address - Street 1:8492 RICHMOND HWY
Practice Address - Street 2:104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-8492
Practice Address - Country:US
Practice Address - Phone:703-780-3482
Practice Address - Fax:703-799-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA72021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA279593Medicare UPIN
VA151891Medicare UPIN