Healthcare Provider Details

I. General information

NPI: 1689512014
Provider Name (Legal Business Name): TERESA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UPLAND LN N
MAPLE GROVE MN
55369-4464
US

IV. Provider business mailing address

12605 FERGUS ST NE
BLAINE MN
55449-3905
US

V. Phone/Fax

Practice location:
  • Phone: 763-363-0063
  • Fax: 763-363-3321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH10972
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: