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General NPI Number Information
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NPI Number | 1851627731
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Entity Type | Individual
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Provider Name | THUAN NGUYEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 5342 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60632
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Country | US
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Telephone | 773-284-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 2606 W 99TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3641
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Country | US
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Telephone | 347-703-2299
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DEN.00203390
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021002625
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN.00303390
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12012141A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002601
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License Number State | IL
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