Healthcare Provider Details

I. General information

NPI: 1093012494
Provider Name (Legal Business Name): QUOC L. NGUYEN, D.D.S. A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA STE 1 C
LAGUNA HILLS CA
92653-4394
US

IV. Provider business mailing address

24953 PASEO DE VALENCIA STE 1 C
LAGUNA HILLS CA
92653-4394
US

V. Phone/Fax

Practice location:
  • Phone: 949-768-4071
  • Fax: 949-768-0292
Mailing address:
  • Phone: 949-768-4071
  • Fax: 949-768-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number59352
License Number StateCA

VIII. Authorized Official

Name: DR. QUOC LAP NGUYEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 949-768-4071