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General NPI Number Information
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NPI Number | 1164157160
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Entity Type | Individual
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Provider Name | PETER NGUYEN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 828 W 6TH ST
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City | CORONA
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State | CA
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Zip | 92882-3237
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Country | US
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Telephone | 951-736-0641
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Fax |
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Provider Business Mailing Address
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Address Line | 3911 ASHWOOD CIR
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City | CORONA
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State | CA
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Zip | 92881-8820
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Country | US
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Telephone | 858-692-3196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107619
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License Number State | CA
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