Healthcare Provider Details

I. General information

NPI: 1740031202
Provider Name (Legal Business Name): TRANG NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 THOMAS RD STE 203
SANTA CLARA CA
95054-2063
US

IV. Provider business mailing address

3700 THOMAS RD STE 203
SANTA CLARA CA
95054-2063
US

V. Phone/Fax

Practice location:
  • Phone: 408-703-5085
  • Fax: 408-703-5086
Mailing address:
  • Phone: 408-703-5085
  • Fax: 408-703-5086

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: TRANG NGUYEN
Title or Position: CEO
Credential: DMD
Phone: 218-348-7453