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General NPI Number Information
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NPI Number | 1396744629
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Entity Type | Organization
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Legal Business Name | SUMMIT ORTHODONTICS
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 15258 SUMMIT AVE SUITE 300
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City | FONTANA
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State | CA
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Zip | 92336-0233
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Country | US
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Telephone | 909-646-9600
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Fax | 909-646-9878
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Provider Business Mailing Address
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Address Line | 15258 SUMMIT AVE SUITE 300
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City | FONTANA
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State | CA
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Zip | 92336-0233
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Country | US
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Telephone | 909-646-9600
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Fax | 909-646-9878
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER
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Name | DR. HENRY MINH NGUYEN
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Credential | D.M.D.
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Telephone | 909-646-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 52662
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License Number State | CA
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