Healthcare Provider Details

I. General information

NPI: 1477661924
Provider Name (Legal Business Name): HA MINH NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NW 23 ST
OKC OK
73107
US

IV. Provider business mailing address

2750 NW 23 ST
OKC OK
73107
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-4445
  • Fax:
Mailing address:
  • Phone: 405-942-4445
  • Fax: 405-943-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: