Healthcare Provider Details

I. General information

NPI: 1326596693
Provider Name (Legal Business Name): TOAN D NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N SAN DIMAS AVE
SAN DIMAS CA
91773-2649
US

IV. Provider business mailing address

213 N SAN DIMAS AVE
SAN DIMAS CA
91773-2649
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1398
  • Fax:
Mailing address:
  • Phone: 909-599-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TOAN NGUYEN
Title or Position: OWNER
Credential:
Phone: 909-599-3398