Provider Demographics
NPI:1417797671
Name:NGUYEN, JACOB HIEP (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:HIEP
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MERRY REST WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3889
Mailing Address - Country:US
Mailing Address - Phone:303-667-2539
Mailing Address - Fax:
Practice Address - Street 1:2850 MERRY REST WAY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3889
Practice Address - Country:US
Practice Address - Phone:303-667-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002027004124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist