Healthcare Provider Details

I. General information

NPI: 1023623865
Provider Name (Legal Business Name): NGUYEN AND TRAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 HELLYER AVENUE
SAN JOSE CA
95138
US

IV. Provider business mailing address

2680 S WHITE ROAD SUITE 255
SAN JOSE CA
95148
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-2647
  • Fax: 408-238-2716
Mailing address:
  • Phone: 408-238-2647
  • Fax: 408-238-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW NGUYEN
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 408-238-2647