Healthcare Provider Details

I. General information

NPI: 1649184870
Provider Name (Legal Business Name): VAN H NGUYEN DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N ILLINOIS 83 STE E
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

1227 N ILLINOIS 83 STE E
GRAYSLAKE IL
60030
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-2222
  • Fax:
Mailing address:
  • Phone: 847-548-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VAN HONG NGUYEN
Title or Position: DENTIST
Credential: DMD
Phone: 479-622-1996