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NPI Code Detail

MEDICARE: LEAN NGUYEN DMD

MEDICARE: LEAN 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
11223G0001XGeneral Practice Dentistry2003018141MO

General Provider Information

NPI Number : 1740363142
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAN NGUYEN DMD
Provider Business Mailing Address
First Line : 3546 GRAVOIS AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118
Country : US
Telephone Number : 314-773-3666
Fax Number :
Provider Business Practice Location Address
First Line : 3546 GRAVOIS AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118
Country : US
Telephone Number : 314-773-3666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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Directions to “ LEAN NGUYEN DMD” Practice Location

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