Healthcare Provider Details

I. General information

NPI: 1225796402
Provider Name (Legal Business Name): HARRISON NGUYEN DDS MSD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MURRIETA BLVD
LIVERMORE CA
94550-4111
US

IV. Provider business mailing address

1034 MURRIETA BLVD
LIVERMORE CA
94550-4111
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-3636
  • Fax: 925-443-3655
Mailing address:
  • Phone: 925-443-3636
  • Fax: 925-443-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: HARRISON NGUYEN
Title or Position: PRESIDENT
Credential: DDS, MSD
Phone: 925-443-3636