Healthcare Provider Details

I. General information

NPI: 1831977495
Provider Name (Legal Business Name): ELIZABETH B NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 EL CAMINO REAL
REDWOOD CITY CA
94063-2850
US

IV. Provider business mailing address

2480 EL CAMINO REAL
REDWOOD CITY CA
94063-2850
US

V. Phone/Fax

Practice location:
  • Phone: 650-216-8488
  • Fax: 650-216-7488
Mailing address:
  • Phone: 650-216-8488
  • Fax: 650-216-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH B NGUYEN
Title or Position: CEO
Credential: DDS
Phone: 650-216-8488