Healthcare Provider Details

I. General information

NPI: 1194458935
Provider Name (Legal Business Name): ANDY TAM NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 BELLE TERRE BLVD
LA PLACE LA
70068-2433
US

IV. Provider business mailing address

393 BELLE TERRE BLVD
LA PLACE LA
70068-2433
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61322595
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7817
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: