Provider Demographics
NPI:1588493035
Name:NGUYEN, CORTNEY A (DMD)
Entity type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:A
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10143 NEWMINSTER LOOP
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6727
Mailing Address - Country:US
Mailing Address - Phone:941-345-6990
Mailing Address - Fax:
Practice Address - Street 1:10451 STELLING DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7594
Practice Address - Country:US
Practice Address - Phone:813-359-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN294751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice