MEDICARE: DR. BRANDON NGUYEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	00204079	CO

General Provider Information

NPI Number	:	1386297539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON NGUYEN DDS

Provider Business Mailing Address
First Line	:	9601 E ILIFF AVE APT 1307
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-3455
Country	:	US
Telephone Number	:	480-518-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	3494 EAGLE BLVD
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-7403
Country	:	US
Telephone Number	:	303-957-3127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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