Healthcare Provider Details

I. General information

NPI: 1275450611
Provider Name (Legal Business Name): NAM H. NGUYEN, DDS, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

705 PRESIDENT ST APT 3
BROOKLYN NY
11215-1260
US

IV. Provider business mailing address

705 PRESIDENT ST APT 3
BROOKLYN NY
11215-1260
US

V. Phone/Fax

Practice location:
  • Phone: 813-767-0093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAM NGUYEN
Title or Position: SURGEON
Credential: DDS, MD
Phone: 813-767-0093