MEDICARE: MARY PHUOC NGUYEN, DMD, INC

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	45161	CA

General Provider Information

NPI Number	:	1588789184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY PHUOC NGUYEN, DMD, INC

Provider Business Mailing Address
First Line	:	13242 CENTURY BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1247
Country	:	US
Telephone Number	:	714-638-7359
Fax Number	:	714-638-7399

Provider Business Practice Location Address
First Line	:	13242 CENTURY BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1247
Country	:	US
Telephone Number	:	714-638-7359
Fax Number	:	714-638-7399

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARY PHUOC THI NGUYEN
Credential	:	D,M.D.
Telephone Number	:	714-638-7359

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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