Provider Demographics
NPI:1316176175
Name:NGUYEN, TUNG D (DMD)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 LEMOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-1339
Mailing Address - Country:US
Mailing Address - Phone:315-420-8578
Mailing Address - Fax:315-452-2705
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:3K
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2700
Practice Address - Fax:315-452-2705
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0552081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice