Provider Demographics
NPI:1649031980
Name:NGUYEN, AN NHAT DUY (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:AN
Middle Name:NHAT DUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CAMBY RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5516
Mailing Address - Country:US
Mailing Address - Phone:510-316-0160
Mailing Address - Fax:
Practice Address - Street 1:2561 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4207
Practice Address - Country:US
Practice Address - Phone:510-969-0788
Practice Address - Fax:510-730-2911
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1096961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice