Provider Demographics
NPI:1558819706
Name:NGUYEN, ANTHONY (DMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11929 OAK HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9401
Mailing Address - Country:US
Mailing Address - Phone:469-878-2947
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7739
Practice Address - Country:US
Practice Address - Phone:805-538-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322141223G0001X
CA1021461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice