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General NPI Number Information
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NPI Number | 1700447380
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Entity Type | Individual
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Provider Name | AN LE-DUY NGUYEN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 3014 E MILTON AVE
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5588
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Country | US
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Telephone | 337-857-3750
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Fax |
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Provider Business Mailing Address
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Address Line | 205 CROOKED STICK LN
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City | LAFAYETTE
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State | LA
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Zip | 70506-7542
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Country | US
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Telephone | 407-222-6747
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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 | 7006
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License Number State | LA
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