Provider Demographics
NPI:1841990504
Name:HUYNH, UYEN THAI (DMD)
Entity type:Individual
Prefix:
First Name:UYEN
Middle Name:THAI
Last Name:HUYNH
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 1:475 WINTER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1214
Mailing Address - Country:US
Mailing Address - Phone:781-209-5456
Mailing Address - Fax:
Practice Address - Street 1:475 WINTER ST STE 9
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1214
Practice Address - Country:US
Practice Address - Phone:781-209-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100002481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice