Provider Demographics
NPI:1912107871
Name:NGUYEN, TUONG (BDS, MSD)
Entity Type:Individual
Prefix:
First Name:TUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 W MEADOWS DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1776
Mailing Address - Country:US
Mailing Address - Phone:503-763-0167
Mailing Address - Fax:
Practice Address - Street 1:620 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4001
Practice Address - Country:US
Practice Address - Phone:503-327-4396
Practice Address - Fax:503-255-1542
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics