Provider Demographics
NPI:1528688645
Name:NGUYEN, CHRISTOPHER THAI (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2056
Mailing Address - Country:US
Mailing Address - Phone:717-215-3317
Mailing Address - Fax:
Practice Address - Street 1:258 DUFFIELD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5303
Practice Address - Country:US
Practice Address - Phone:717-215-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061982-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice