Healthcare Provider Details

I. General information

NPI: 1336157429
Provider Name (Legal Business Name): LOAN T NGUYEN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ALPINE RD
ROCKFORD IL
61107-2262
US

IV. Provider business mailing address

7181 ROBINSWOOD ST
ROCKFORD IL
61114-8023
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-4280
  • Fax: 815-484-2436
Mailing address:
  • Phone: 815-639-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: