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General NPI Number Information
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NPI Number | 1033395413
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Entity Type | Organization
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Legal Business Name | DAT NGUYEN, D.D.S., INC.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 555 N CENTRAL AVE
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City | UPLAND
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State | CA
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Zip | 91786-4241
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Country | US
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Telephone | 909-982-5960
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Fax | 909-982-7694
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Provider Business Mailing Address
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Address Line | 555 N CENTRAL AVE
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City | UPLAND
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State | CA
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Zip | 91786-4241
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Country | US
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Telephone | 909-982-5960
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Fax | 909-982-7694
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAT NGUYEN
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Credential | DDS
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Telephone | 909-982-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54670
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License Number State | CA
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