Provider Demographics
NPI:1386297539
Name:NGUYEN, BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
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 1:9601 E ILIFF AVE APT 1307
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3455
Mailing Address - Country:US
Mailing Address - Phone:480-518-6476
Mailing Address - Fax:
Practice Address - Street 1:3494 EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7403
Practice Address - Country:US
Practice Address - Phone:303-957-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist