Provider Demographics
NPI:1699895185
Name:NGUYEN, ROSALIE P (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:P
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 1:3 COLUMBUS PL
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1057
Mailing Address - Country:US
Mailing Address - Phone:973-886-1181
Mailing Address - Fax:201-313-7163
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 204A
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-313-5437
Practice Address - Fax:201-313-7163
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021987001223P0221X
NY0505111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry