Healthcare Provider Details

I. General information

NPI: 1427559699
Provider Name (Legal Business Name): TOAN NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N COAST HWY STE 110
LAGUNA BEACH CA
92651-1526
US

IV. Provider business mailing address

610 N COAST HWY STE 110
LAGUNA BEACH CA
92651-1526
US

V. Phone/Fax

Practice location:
  • Phone: 949-497-4900
  • Fax: 949-497-4900
Mailing address:
  • Phone: 949-497-4900
  • Fax: 949-497-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number45302
License Number StateCA

VIII. Authorized Official

Name: DR. TOAN DUY NGUYEN
Title or Position: OWNER
Credential: DDS
Phone: 949-497-4900