Healthcare Provider Details

I. General information

NPI: 1689828873
Provider Name (Legal Business Name): NGUYEN, MINH, DDS A DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12880 BEACH BLVD SUITE AA
STANTON CA
90680
US

IV. Provider business mailing address

12880 BEACH BLVD SUITE AA
STANTON CA
90680
US

V. Phone/Fax

Practice location:
  • Phone: 714-890-1122
  • Fax: 714-896-9512
Mailing address:
  • Phone: 714-890-1122
  • Fax: 714-896-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45505
License Number StateCA

VIII. Authorized Official

Name: MR. MINH DUC NGUYEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-890-1122