Provider Demographics
NPI:1952734659
Name:NGUYEN, TONY TU (DMD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:TU
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 1:13215 NE SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-3024
Mailing Address - Country:US
Mailing Address - Phone:503-807-8128
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD
Practice Address - Street 2:SUITE #240
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60397210122300000X
ORD10017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist