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General NPI Number Information
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NPI Number | 1518428374
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Entity Type | Organization
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Legal Business Name | SPRINGDALE MODERN DENTISTRY, PC, INC.
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 403 E KEMPER RD
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City | SPRINGDALE
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State | OH
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Zip | 45246-3228
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Country | US
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Telephone | 513-729-7245
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DR. BACH X NGUYEN
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Credential | DDS
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Telephone | 513-729-7245
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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 |
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License Number State |
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