Healthcare Provider Details

I. General information

NPI: 1043228489
Provider Name (Legal Business Name): HOANG CAM T. NGUYEN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST UNIV @ BUFFALO, SDM/RESTORATIVE DEPT
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

1500 BROADWAY ST STE 170
BUFFALO NY
14212-1845
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2862
  • Fax: 716-829-2440
Mailing address:
  • Phone: 716-645-8999
  • Fax: 716-893-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: