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General NPI Number Information
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NPI Number | 1558819706
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Entity Type | Individual
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Provider Name | ANTHONY NGUYEN DMD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4251 S HIGUERA ST STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7739
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Country | US
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Telephone | 805-538-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 11929 OAK HIGHLAND DR
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City | DALLAS
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State | TX
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Zip | 75243-9401
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Country | US
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Telephone | 469-878-2947
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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 | 32214
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102146
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License Number State | CA
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