Provider Demographics
NPI:1780414946
Name:NGUYEN, MINH N
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16235 NW CANTON ST # 2-101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1260
Mailing Address - Country:US
Mailing Address - Phone:971-263-9625
Mailing Address - Fax:
Practice Address - Street 1:15715 NW CENTRAL DR # 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1267
Practice Address - Country:US
Practice Address - Phone:503-610-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist