Provider Demographics
NPI:1699054205
Name:NGUYEN, TOAI THANH (DDS)
Entity type:Individual
Prefix:DR
First Name:TOAI
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SENTER RD
Mailing Address - Street 2:SPACE 257
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1150
Mailing Address - Country:US
Mailing Address - Phone:718-473-7625
Mailing Address - Fax:
Practice Address - Street 1:530 SHOWERS DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4740
Practice Address - Country:US
Practice Address - Phone:718-473-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist