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General NPI Number Information
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NPI Number | 1528163441
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Entity Type | Organization
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Legal Business Name | B. NGUYEN DENTAL CORPORATION
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 14427 CULVER DR
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City | IRVINE
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State | CA
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Zip | 92604-0305
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Country | US
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Telephone | 949-733-0486
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Fax | 949-733-0489
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE DRIVE 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606-1009
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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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 | 949-733-0486
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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 | 49784
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License Number State | CA
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