Provider Demographics
NPI:1427060961
Name:DINH, THERESE THIEN-NGA (DDS)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:THIEN-NGA
Last Name:DINH
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 1:10970 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5440
Mailing Address - Country:US
Mailing Address - Phone:225-275-3837
Mailing Address - Fax:225-275-3893
Practice Address - Street 1:1119 TAMARI DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-7605
Practice Address - Country:US
Practice Address - Phone:225-275-3837
Practice Address - Fax:225-275-3893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1845442Medicaid