Healthcare Provider Details

I. General information

NPI: 1336021559
Provider Name (Legal Business Name): MICHAEL HUU NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 FORT ST STE 106
OMAHA NE
68164-2183
US

IV. Provider business mailing address

11110 FORT ST STE 106
OMAHA NE
68164-2183
US

V. Phone/Fax

Practice location:
  • Phone: 402-492-8300
  • Fax:
Mailing address:
  • Phone: 402-492-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8187
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: