=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154481661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESTHETIC AND SPECIAL CARE ASSOCIATES,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 01/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 PENNSYLVANIA AVE LOWER LEVEL
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-426-0526
-----------------------------------------------------
Fax | 302-426-0511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2323 PENNSYLVANIA AVE LOWER LEVEL
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-482-4444
-----------------------------------------------------
Fax | 302-482-4446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEITH T NGUYEN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 302-482-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | G10000859 G10001149
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------