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General NPI Number Information
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NPI Number | 1164562724
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Entity Type | Organization
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Legal Business Name | TONTHAT AND NGUYEN PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 434 W HARDER RD
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City | HAYWARD
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State | CA
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Zip | 94544-2130
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Country | US
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Telephone | 510-293-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 434 W HARDER RD
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City | HAYWARD
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State | CA
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Zip | 94544-2130
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Country | US
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Telephone | 510-293-0900
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | LOAN NGUYEN
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Credential |
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Telephone | 510-293-0900
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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 | 42201
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License Number State | CA
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