Healthcare Provider Details

I. General information

NPI: 1720118920
Provider Name (Legal Business Name): PETER B NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S PACIFIC ST SUITE #100
SAN MARCOS CA
92078-2476
US

IV. Provider business mailing address

250 S PACIFIC ST STE 100
SAN MARCOS CA
92078-2476
US

V. Phone/Fax

Practice location:
  • Phone: 760-597-9999
  • Fax: 760-798-7960
Mailing address:
  • Phone: 760-597-9999
  • Fax: 760-798-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number47536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: