Provider Demographics
NPI:1972735660
Name:NGUYEN, PETER DINH (DDS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DINH
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 1:88 TULLY ROAD, #112
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1923
Mailing Address - Country:US
Mailing Address - Phone:408-280-7618
Mailing Address - Fax:408-766-7412
Practice Address - Street 1:88 TULLY ROAD
Practice Address - Street 2:#112
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1923
Practice Address - Country:US
Practice Address - Phone:408-280-7618
Practice Address - Fax:408-766-7412
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist