=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780736819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE D. NGUYEN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1029 CLEVELAND AVE
-----------------------------------------------------
City | EAST POINT
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30344-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-761-1542
-----------------------------------------------------
Fax | 404-761-1778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1029 CLEVELAND AVE
-----------------------------------------------------
City | EAST POINT
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30344-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-761-1542
-----------------------------------------------------
Fax | 404-761-1778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0011765
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------