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General NPI Number Information
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NPI Number | 1528273299
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Entity Type | Individual
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Provider Name | CAM-TU NGUYEN DALLUGE 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 | 08/24/2016
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Provider Practice Location Address
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Address Line | 500 WEST 79TH STREET RADIANCE DENTAL
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City | CHANHASSEN
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State | MN
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Zip | 55317
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Country | US
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Telephone | 952-934-7987
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Fax |
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Provider Business Mailing Address
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Address Line | 500 WEST 79TH STREET RADIANCE DENTAL
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City | CHANHASSEN
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State | MN
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Zip | 55317
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Country | US
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Telephone | 952-934-7987
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11572
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License Number State | MN
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