Healthcare Provider Details

I. General information

NPI: 1164554812
Provider Name (Legal Business Name): PNT NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 IRVINE CENTER DRIVE S 100
IRVINE CA
92604
US

IV. Provider business mailing address

4902 IRVINE CENTER DRIVE S 100
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-654-8600
  • Fax: 949-654-8607
Mailing address:
  • Phone: 949-654-8600
  • Fax: 949-654-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number44969
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL N.T. NGUYEN
Title or Position: PRESIDENT/OWNER
Credential: D.D.S.
Phone: 949-654-8600