Provider Demographics
NPI:1720758824
Name:NGUYEN, CECELIA NGOC
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8602
Mailing Address - Country:US
Mailing Address - Phone:928-249-3673
Mailing Address - Fax:918-341-4001
Practice Address - Street 1:2241 S AVENUE A STE 7
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8374
Practice Address - Country:US
Practice Address - Phone:928-783-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011116122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist