Healthcare Provider Details

I. General information

NPI: 1861875866
Provider Name (Legal Business Name): MICHELE LY NGUYEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MONTAGUE ST STE 9
BROOKLYN NY
11201-3637
US

IV. Provider business mailing address

233 SCHERMERHORN ST APT 9B
BROOKLYN NY
11201-5874
US

V. Phone/Fax

Practice location:
  • Phone: 718-638-5100
  • Fax:
Mailing address:
  • Phone: 504-231-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number058957
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: