Healthcare Provider Details

I. General information

NPI: 1407918402
Provider Name (Legal Business Name): NIKKI TRINH THUY NGUYEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5812 MAPLEDALE PLZ
DALE CITY VA
22193-4535
US

IV. Provider business mailing address

5812 MAPLEDALE PLZ
DALE CITY VA
22193-4535
US

V. Phone/Fax

Practice location:
  • Phone: 703-580-9900
  • Fax: 703-580-0358
Mailing address:
  • Phone: 703-580-9900
  • Fax: 703-580-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401007918
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: