Provider Demographics
NPI:1992812812
Name:NGUYEN, MAU K (DDS)
Entity type:Individual
Prefix:DR
First Name:MAU
Middle Name:K
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 1:32099 CAMINO RABAGO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1363
Mailing Address - Country:US
Mailing Address - Phone:951-246-8262
Mailing Address - Fax:951-246-8277
Practice Address - Street 1:27180 NEWPORT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7385
Practice Address - Country:US
Practice Address - Phone:951-246-8262
Practice Address - Fax:951-246-8277
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice