Healthcare Provider Details

I. General information

NPI: 1124712849
Provider Name (Legal Business Name): WILLIAM DON NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 COORS BLVD NW STE G4
ALBUQUERQUE NM
87120-1877
US

IV. Provider business mailing address

5600 COORS BLVD NW STE G4
ALBUQUERQUE NM
87120-1877
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-9740
  • Fax:
Mailing address:
  • Phone: 714-594-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2026-0206
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: