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General NPI Number Information
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NPI Number | 1386440568
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Entity Type | Individual
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Provider Name | NGUYEN MAI DMD
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Gender | Male
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 845 SCENIC HWY STE 300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7104
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Country | US
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Telephone | 770-277-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 600 SHINEY BROOK LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-6632
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Country | US
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Telephone | 404-395-6911
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN123623
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License Number State | GA
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