Provider Demographics
NPI:1881954410
Name:BRIAN P. NGUYEN, DMD, PLLC ORAL AND MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:BRIAN P. NGUYEN, DMD, PLLC ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:PHI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-777-1800
Mailing Address - Street 1:2628 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8015
Mailing Address - Country:US
Mailing Address - Phone:615-777-1800
Mailing Address - Fax:615-777-3707
Practice Address - Street 1:2628 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8015
Practice Address - Country:US
Practice Address - Phone:615-777-1800
Practice Address - Fax:615-777-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000009075261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524821Medicaid