Provider Demographics
NPI:1306902895
Name:NGUYEN, BINH CONG (DDS)
Entity type:Individual
Prefix:DR
First Name:BINH
Middle Name:CONG
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 1:13042 SIEMON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2242
Mailing Address - Country:US
Mailing Address - Phone:714-588-1067
Mailing Address - Fax:
Practice Address - Street 1:10022 IMPERIAL AVE
Practice Address - Street 2:STE. A
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2370
Practice Address - Country:US
Practice Address - Phone:714-534-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice