Healthcare Provider Details

I. General information

NPI: 1437104643
Provider Name (Legal Business Name): HUY DINH NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22500 ALLEN RD
WOODHAVEN MI
48183-2238
US

IV. Provider business mailing address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-7878
  • Fax: 734-676-6347
Mailing address:
  • Phone: 313-582-8150
  • Fax: 313-582-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019227
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: