Provider Demographics
NPI:1386706422
Name:NGUYEN, LOC VAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LOC
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LOC
Other - Middle Name:VAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31625 HIGHWAY 101 S
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-9529
Mailing Address - Country:US
Mailing Address - Phone:831-678-5500
Mailing Address - Fax:831-678-6245
Practice Address - Street 1:31625 HIGHWAY 101 S
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-9529
Practice Address - Country:US
Practice Address - Phone:831-678-5500
Practice Address - Fax:831-678-6245
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist