Healthcare Provider Details

I. General information

NPI: 1265182422
Provider Name (Legal Business Name): OLIVIA NGUYEN BA, MS, DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TOWNE AVE
PLAINFIELD VT
05667-9425
US

IV. Provider business mailing address

1394 STAGE RD
RICHMOND VT
05477-9633
US

V. Phone/Fax

Practice location:
  • Phone: 802-454-1047
  • Fax:
Mailing address:
  • Phone: 802-454-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0160134189
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: