MEDICARE: DR. LAWRENCE VU NGUYEN D.D.S.

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	1223G0001X	General Practice Dentistry	44750	CA

General Provider Information

NPI Number	:	1790704278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE VU NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	6009 LITTLE ROCK RD
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4204
Country	:	US
Telephone Number	:	916-435-5255
Fax Number	:	916-435-5115

Provider Business Practice Location Address
First Line	:	5440 PARK DR
Second Line	:	SUITE 100
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5562
Country	:	US
Telephone Number	:	916-435-5255
Fax Number	:	916-435-5115

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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