Healthcare Provider Details

I. General information

NPI: 1730395146
Provider Name (Legal Business Name): TNT DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14541 BROOKHURST ST STE C4
WESTMINSTER CA
92683-5784
US

IV. Provider business mailing address

14541 BROOKHURST ST STE C4
WESTMINSTER CA
92683-5784
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-2911
  • Fax: 714-775-3105
Mailing address:
  • Phone: 714-775-2911
  • Fax: 714-775-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD36808
License Number StateCA

VIII. Authorized Official

Name: DR. TAN Q NGUYEN
Title or Position: PARTNER
Credential:
Phone: 714-775-2911