Provider Demographics
NPI:1215059696
Name:NGUYEN, JACQUELINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:BAO NHU
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2847 S WHITE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2942
Mailing Address - Country:US
Mailing Address - Phone:408-238-8380
Mailing Address - Fax:408-238-8404
Practice Address - Street 1:2847 S WHITE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2942
Practice Address - Country:US
Practice Address - Phone:408-238-8380
Practice Address - Fax:408-238-8404
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist