Healthcare Provider Details

I. General information

NPI: 1578764882
Provider Name (Legal Business Name): JENNIFER BICHLOAN NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 4TH AVE SUITE 1230
SEATTLE WA
98101-2573
US

IV. Provider business mailing address

1325 4TH AVE SUITE 1230
SEATTLE WA
98101-2573
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-1773
  • Fax: 206-624-2268
Mailing address:
  • Phone: 206-624-1773
  • Fax: 206-624-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60226224
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12391
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: