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General NPI Number Information
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NPI Number | 1659598852
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Entity Type | Organization
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Legal Business Name | THANH QUOC NGUYEN DDS, INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 319 E 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92706-4108
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Country | US
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Telephone | 714-569-1100
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Fax | 714-547-1235
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Provider Business Mailing Address
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Address Line | 319 E 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92706-4108
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Country | US
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Telephone | 714-569-1100
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Fax | 714-547-1235
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Authorized Official
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Title or Position | PRESIDENT
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Name | THANH QUOC NGUYEN
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Credential | DDS
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Telephone | 714-569-1100
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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 | 43551
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License Number State | CA
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