Healthcare Provider Details

I. General information

NPI: 1992356075
Provider Name (Legal Business Name): MINH B NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 PARK DR # 100
ROCKLIN CA
95765-5562
US

IV. Provider business mailing address

5400 PARK DR # 100
ROCKLIN CA
95765-5562
US

V. Phone/Fax

Practice location:
  • Phone: 916-435-1155
  • Fax: 916-435-1152
Mailing address:
  • Phone: 916-435-1155
  • Fax: 916-435-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MINH NGUYEN
Title or Position: CEO
Credential: DDS
Phone: 916-390-2784