Provider Demographics
NPI:1841315611
Name:NGUYEN, BRANDON T (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3081
Mailing Address - Country:US
Mailing Address - Phone:562-599-3838
Mailing Address - Fax:562-599-6818
Practice Address - Street 1:1360 E ANAHEIM ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5514
Practice Address - Country:US
Practice Address - Phone:562-599-3838
Practice Address - Fax:562-599-6818
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93124-01OtherDENTICAL