=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124179320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRI NGUYEN, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 05/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 W PORTAL AVE SUITE #4
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94127-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-661-7779
-----------------------------------------------------
Fax | 415-592-0137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 W PORTAL AVE SUITE #4
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94127-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-661-7779
-----------------------------------------------------
Fax | 415-592-0137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. TERRI M NGUYEN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 415-661-7779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------