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General NPI Number Information
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NPI Number | 1174916902
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Entity Type | Organization
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Legal Business Name | TAN BINH NGUYEN, DDS II, PLLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 5511 RAEFORD RD STE 225
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2060
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Country | US
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Telephone | 910-485-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 THORNGROVE CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4099
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Country | US
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Telephone | 910-263-8034
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | DR. TAN BINH PHAN NGUYEN
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Credential | D.D.S.
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Telephone | 678-761-2457
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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 | 9227
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License Number State | NC
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