Provider Demographics
NPI:1487765954
Name:NGUYEN-NGO, NATHALIE JOSEPHINE (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:JOSEPHINE
Last Name:NGUYEN-NGO
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 1:6246 N 1ST ST
Mailing Address - Street 2:102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5446
Mailing Address - Country:US
Mailing Address - Phone:559-436-1790
Mailing Address - Fax:
Practice Address - Street 1:6246 N 1ST ST
Practice Address - Street 2:102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5446
Practice Address - Country:US
Practice Address - Phone:559-436-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41659OtherDENTI-CAL PROVIDER NUMBER