Healthcare Provider Details

I. General information

NPI: 1720500283
Provider Name (Legal Business Name): ROBERT ANH MINH NGUYEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6432 W COLONIAL DR
ORLANDO FL
32818-6820
US

IV. Provider business mailing address

14 W EVANS ST
ORLANDO FL
32804-3822
US

V. Phone/Fax

Practice location:
  • Phone: 407-293-9573
  • Fax:
Mailing address:
  • Phone: 407-452-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: