Healthcare Provider Details

I. General information

NPI: 1871512129
Provider Name (Legal Business Name): HUNG Q NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N GREENFIELD RD SUITE 111
GILBERT AZ
85234-5044
US

IV. Provider business mailing address

255 S. DOBSON RD SUITE 3
CHANDLER AZ
85224
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-1988
  • Fax: 480-558-9188
Mailing address:
  • Phone: 480-722-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD 4917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: