Provider Demographics
NPI:1811277015
Name:NGUYEN, ANTHONY M (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
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 1:13704 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1601
Mailing Address - Country:US
Mailing Address - Phone:626-917-3088
Mailing Address - Fax:626-917-9333
Practice Address - Street 1:13704 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1601
Practice Address - Country:US
Practice Address - Phone:626-917-3088
Practice Address - Fax:626-917-9333
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice