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General NPI Number Information
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NPI Number | 1881783637
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Entity Type | Organization
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Legal Business Name | NGUYEN AND REAGAN DENTAL CORPORATION
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 3030 HARBOR BLVD STE. G-1
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City | COSTA MESA
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State | CA
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Zip | 92626-2562
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Country | US
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Telephone | 714-546-6100
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Fax | 714-546-6160
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL NGUYEN
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Credential | DMD
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Telephone | 714-546-6100
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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 |
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License Number State |
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