Provider Demographics
NPI:1992715759
Name:NGUYEN, HAO VAN (DDS)
Entity type:Individual
Prefix:DR
First Name:HAO
Middle Name:VAN
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 1:4545 GEORGETOWN PL
Mailing Address - Street 2:SUITE B 8
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6215
Mailing Address - Country:US
Mailing Address - Phone:209-478-6466
Mailing Address - Fax:209-478-6467
Practice Address - Street 1:4545 GEORGETOWN PL
Practice Address - Street 2:SUITE B 8
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6215
Practice Address - Country:US
Practice Address - Phone:209-478-6466
Practice Address - Fax:209-478-6467
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist