Healthcare Provider Details

I. General information

NPI: 1083062020
Provider Name (Legal Business Name): NHU NGUYEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 NW BURNSIDE RD
GRESHAM OR
97030-3851
US

IV. Provider business mailing address

315 NW BURNSIDE RD
GRESHAM OR
97030-3851
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5484
  • Fax:
Mailing address:
  • Phone: 503-954-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10537
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: