Provider Demographics
NPI:1396322517
Name:NGUYEN, BACH (DDS)
Entity type:Individual
Prefix:DR
First Name:BACH
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 1:4020 LAFAYETTE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1500
Mailing Address - Country:US
Mailing Address - Phone:571-830-4299
Mailing Address - Fax:
Practice Address - Street 1:4020 LAFAYETTE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1500
Practice Address - Country:US
Practice Address - Phone:571-830-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170641223G0001X
DCDEN10021711223G0001X
VA04014173151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice