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NPI Code Detail

MEDICARE: DAI THE NGUYEN DMD

MEDICARE: DAI THE NGUYEN DMD
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
1122300000XDentistG9-0010553DE
2122300000XDentistDS045403PA

General Provider Information

NPI Number : 1588493530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAI THE NGUYEN DMD
Provider Business Mailing Address
First Line : 100 S BLISS AVE
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-2512
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 S BLISS AVE
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-2512
Country : US
Telephone Number : 918-458-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2024
Last Update Date : 06/16/2026

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Directions to “ DAI THE NGUYEN DMD” Practice Location

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