Provider Demographics
NPI:1881370005
Name:NGUYEN, KATHLEEN (DMD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NGUYEN
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 1:6659 W MONONA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6650
Mailing Address - Country:US
Mailing Address - Phone:408-600-9344
Mailing Address - Fax:
Practice Address - Street 1:14858 N FRANK LLOYD WRIGHT BLVD STE 165A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2216
Practice Address - Country:US
Practice Address - Phone:480-860-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist