Provider Demographics
NPI:1982746921
Name:NGUYENDUC, THERESA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:NGUYENDUC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 BRISTOL ST.
Mailing Address - Street 2:#110
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 BRISTOL ST.
Practice Address - Street 2:#110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8201
Practice Address - Country:US
Practice Address - Phone:714-979-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39853OtherDENTI-CAL