Provider Demographics
NPI:1982983953
Name:NGUYEN, JONATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 AVRON BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1016
Mailing Address - Country:US
Mailing Address - Phone:504-782-6813
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHWAY 190
Practice Address - Street 2:SUITE 4
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5003
Practice Address - Country:US
Practice Address - Phone:985-893-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27106122300000X
LA6373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist