Healthcare Provider Details

I. General information

NPI: 1407881170
Provider Name (Legal Business Name): TUNG T NGUYEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E CONE BLVD
GREENSBORO NC
27405-4546
US

IV. Provider business mailing address

1112 E CONE BLVD
GREENSBORO NC
27405-4546
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-0456
  • Fax: 336-510-0457
Mailing address:
  • Phone: 336-510-0456
  • Fax: 336-510-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7227
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7227
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: