Provider Demographics
NPI:1720175003
Name:NGUYEN, MANUEL PHU (DDS)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:PHU
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 1:14292 VILLAGE WAY
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1506
Mailing Address - Country:US
Mailing Address - Phone:714-902-3764
Mailing Address - Fax:
Practice Address - Street 1:2 MACARTHUR PL
Practice Address - Street 2:SUITE 700
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5924
Practice Address - Country:US
Practice Address - Phone:714-850-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist