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General NPI Number Information
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NPI Number | 1578237525
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Entity Type | Individual
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Provider Name | LISA NGUYEN DMD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 2239 HIGHWAY 20 SE STE H
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City | CONYERS
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State | GA
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Zip | 30013-2087
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Country | US
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Telephone | 770-921-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 DYLAN CHASE
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City | MARIETTA
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State | GA
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Zip | 30066-2712
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Country | US
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Telephone | 404-769-4788
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN016092
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License Number State | GA
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