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General NPI Number Information
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NPI Number | 1013491190
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Entity Type | Organization
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Legal Business Name | DUY NGUYEN DDS, PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 55 BILL DRAKE WAY STE B
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City | PACIFICA
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State | CA
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Zip | 94044-1802
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Country | US
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Telephone | 650-735-1608
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Fax | 888-509-8199
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Provider Business Mailing Address
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Address Line | 55 BILL DRAKE WAY STE B
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City | PACIFICA
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State | CA
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Zip | 94044-1802
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Country | US
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Telephone | 650-735-1608
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Fax | 888-509-8199
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUY MINH NGUYEN
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Credential | DDS
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Telephone | 650-735-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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