Provider Demographics
NPI:1912077439
Name:NGUYEN, NHUT VAN
Entity Type:Individual
Prefix:
First Name:NHUT
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415B DULUTH HIGHWAY 120
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3354
Mailing Address - Country:US
Mailing Address - Phone:678-417-7709
Mailing Address - Fax:678-417-7071
Practice Address - Street 1:3415B DULUTH HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3354
Practice Address - Country:US
Practice Address - Phone:678-417-7709
Practice Address - Fax:678-417-7071
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice