Provider Demographics
NPI:1871083204
Name:NGUYEN, MY THANH (DDS)
Entity type:Individual
Prefix:
First Name:MY
Middle Name:THANH
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 1:6529 INGLEWOOD AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3864
Mailing Address - Country:US
Mailing Address - Phone:209-473-3788
Mailing Address - Fax:
Practice Address - Street 1:6529 INGLEWOOD AVE STE A1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3864
Practice Address - Country:US
Practice Address - Phone:209-473-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1045391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery