Healthcare Provider Details

I. General information

NPI: 1528495793
Provider Name (Legal Business Name): ALEXANDER NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 E OSBORN RD STE 206
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

2470 W EDGEWATER WAY APT 2017
CHANDLER AZ
85248-3010
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-4013
  • Fax:
Mailing address:
  • Phone: 714-906-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD009678
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: