Provider Demographics
NPI:1720080831
Name:NGUYEN, THUAN VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THUAN
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 DUKE ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2924
Mailing Address - Country:US
Mailing Address - Phone:703-823-2848
Mailing Address - Fax:
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:703-823-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13457122300000X
VA0401410942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist