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General NPI Number Information
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NPI Number | 1275749707
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Entity Type | Individual
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Provider Name | MONG-TRINH THI NGUYEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 249 W BROADWAY 2D
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City | NEW YORK
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State | NY
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Zip | 10013-2400
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Country | US
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Telephone | 212-925-4000
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Fax | 212-295-4000
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Provider Business Mailing Address
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Address Line | 249 WEST BROADWAY 2D
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City | NEW YORK
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State | NY
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Zip | 10013
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Country | US
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Telephone | 212-925-4000
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Fax | 212-295-4000
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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 | 043629
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License Number State | NY
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