Provider Demographics
NPI:1316172737
Name:TUAN NGUYEN, DDS, PC
Entity type:Organization
Organization Name:TUAN NGUYEN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-280-1100
Mailing Address - Street 1:3077 NUTLEY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-280-1100
Mailing Address - Fax:703-280-1617
Practice Address - Street 1:3077 NUTLEY ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-280-1100
Practice Address - Fax:703-280-1617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUAN NGUYEN, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty