Healthcare Provider Details

I. General information

NPI: 1841625514
Provider Name (Legal Business Name): VTNGUYEN ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31796 COAST HWY
LAGUNA BEACH CA
92651-6974
US

IV. Provider business mailing address

1175 BAKER ST E19 #220
COSTA MESA CA
92626-4101
US

V. Phone/Fax

Practice location:
  • Phone: 949-415-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number48343
License Number StateCA

VIII. Authorized Official

Name: VINH-THY NGUYEN
Title or Position: CEO
Credential:
Phone: 702-557-9528