Provider Demographics
NPI:1669104725
Name:NGUYEN FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:NGUYEN FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHU
Authorized Official - Middle Name:HUU HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-641-6778
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808
Mailing Address - Country:US
Mailing Address - Phone:517-641-6778
Mailing Address - Fax:
Practice Address - Street 1:5815 E. CLARK RD.
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:MI
Practice Address - Zip Code:48808-4880
Practice Address - Country:US
Practice Address - Phone:517-641-6778
Practice Address - Fax:517-641-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154420040Medicaid