Provider Demographics
NPI:1316914518
Name:NGUYEN, SUSAN T (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2634
Mailing Address - Country:US
Mailing Address - Phone:619-425-9770
Mailing Address - Fax:619-425-9797
Practice Address - Street 1:345 F ST
Practice Address - Street 2:SUITE 240
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2626
Practice Address - Country:US
Practice Address - Phone:619-425-9770
Practice Address - Fax:619-425-9797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics