Healthcare Provider Details

I. General information

NPI: 1609457639
Provider Name (Legal Business Name): THONG TIMOTHY NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

PSC 482 BOX 1600
FPO AP
96362-0017
US

V. Phone/Fax

Practice location:
  • Phone: 315-646-7918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number37462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: