Provider Demographics
NPI:1588789184
Name:MARY PHUOC NGUYEN, DMD, INC
Entity type:Organization
Organization Name:MARY PHUOC NGUYEN, DMD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY PHUOC
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:D,MD
Authorized Official - Phone:714-638-7359
Mailing Address - Street 1:13242 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1247
Mailing Address - Country:US
Mailing Address - Phone:714-638-7359
Mailing Address - Fax:714-638-7399
Practice Address - Street 1:13242 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1247
Practice Address - Country:US
Practice Address - Phone:714-638-7359
Practice Address - Fax:714-638-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty