Healthcare Provider Details

I. General information

NPI: 1720954704
Provider Name (Legal Business Name): JULIE NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR
SANTA FE NM
87505-7672
US

IV. Provider business mailing address

4824 MCMAHON BLVD NW STE 119
ALBUQUERQUE NM
87114-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4867
  • Fax:
Mailing address:
  • Phone: 505-369-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2025-0274
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: