Provider Demographics
NPI:1407052608
Name:NGUYEN, TIFFANY MAI (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 19TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1804
Mailing Address - Country:US
Mailing Address - Phone:415-571-8823
Mailing Address - Fax:415-379-4597
Practice Address - Street 1:2299 19TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1804
Practice Address - Country:US
Practice Address - Phone:415-571-8823
Practice Address - Fax:415-379-4597
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice