Provider Demographics
NPI:1992452759
Name:NGUYEN, DAN THANH LINH (DMD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:THANH LINH
Last Name:NGUYEN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WILKIN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2034
Mailing Address - Country:US
Mailing Address - Phone:781-654-5498
Mailing Address - Fax:
Practice Address - Street 1:52 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2321
Practice Address - Country:US
Practice Address - Phone:413-525-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13415390200000X
MADN100000371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program