Provider Demographics
NPI:1952393449
Name:NGUYEN, HIEP PHUC (DMD)
Entity Type:Individual
Prefix:DR
First Name:HIEP
Middle Name:PHUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5944
Mailing Address - Country:US
Mailing Address - Phone:609-572-0680
Mailing Address - Fax:609-572-0696
Practice Address - Street 1:3805 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5944
Practice Address - Country:US
Practice Address - Phone:609-572-0680
Practice Address - Fax:609-572-0696
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018316001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice