Provider Demographics
NPI:1720350572
Name:NGUYEN, HUONG THIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUONG
Middle Name:THIEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NEW YORK AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5568
Mailing Address - Country:US
Mailing Address - Phone:386-736-5194
Mailing Address - Fax:
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5114
Practice Address - Country:US
Practice Address - Phone:386-274-0500
Practice Address - Fax:386-274-0800
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00127601223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004550500Medicaid