Provider Demographics
NPI:1649719170
Name:NGUYEN, TIFFANY H (DDS)
Entity type:Individual
Prefix:
First Name:TIFFANY
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 1:2391 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1831
Mailing Address - Country:US
Mailing Address - Phone:408-332-7954
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 2633
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4211
Practice Address - Country:US
Practice Address - Phone:415-986-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice