Provider Demographics
NPI:1215925615
Name:NGUYEN, THU DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:DAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 FRUITRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5301
Mailing Address - Country:US
Mailing Address - Phone:916-393-6253
Mailing Address - Fax:916-424-2711
Practice Address - Street 1:5026 FRUITRIDGE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5301
Practice Address - Country:US
Practice Address - Phone:916-393-6253
Practice Address - Fax:916-424-2711
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist