Provider Demographics
NPI:1386440568
Name:MAI, NGUYEN (DMD)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:MAI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SHINEY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6632
Mailing Address - Country:US
Mailing Address - Phone:404-395-6911
Mailing Address - Fax:
Practice Address - Street 1:845 SCENIC HWY STE 300
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7104
Practice Address - Country:US
Practice Address - Phone:770-277-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1236231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice