Healthcare Provider Details

I. General information

NPI: 1235698820
Provider Name (Legal Business Name): NHAN DANG NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9972 BOLSA AVE STE 102
WESTMINSTER CA
92683-6069
US

IV. Provider business mailing address

5940 SHOVELER CT
JURUPA VALLEY CA
91752-2933
US

V. Phone/Fax

Practice location:
  • Phone: 909-319-5858
  • Fax:
Mailing address:
  • Phone: 909-319-5858
  • Fax:

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 Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. NHAN H DANG
Title or Position: PRESIDENT/CEO
Credential: DDS
Phone: 909-319-5858