Provider Demographics
NPI:1588786271
Name:NGUYEN, MICHAEL LUAN PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LUAN PHUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30190 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-363-2540
Mailing Address - Fax:949-363-3352
Practice Address - Street 1:30190 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-363-2540
Practice Address - Fax:949-363-3352
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist