MEDICARE: NGUYEN DO 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	DN17225	FL
2	1223G0001X	General Practice Dentistry	17225	FL

General Provider Information

NPI Number	:	1942311667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGUYEN DO D.D.S.

Provider Business Mailing Address
First Line	:	11915 BEACH BLVD
Second Line	:	STE. 115
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-6704
Country	:	US
Telephone Number	:	904-620-7300
Fax Number	:	904-620-7343

Provider Business Practice Location Address
First Line	:	11915 BEACH BLVD
Second Line	:	STE. 115
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-6704
Country	:	US
Telephone Number	:	904-620-7300
Fax Number	:	904-620-7343

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/12/2019

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Directions to “ NGUYEN DO D.D.S.” Practice Location

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