Provider Demographics
NPI:1124251434
Name:NGUYEN, THY (DDS)
Entity type:Individual
Prefix:
First Name:THY
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 1:19873 CENTURY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7211
Mailing Address - Country:US
Mailing Address - Phone:301-503-4595
Mailing Address - Fax:
Practice Address - Street 1:19873 CENTURY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7211
Practice Address - Country:US
Practice Address - Phone:301-363-4300
Practice Address - Fax:301-363-4879
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist