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General NPI Number Information
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NPI Number | 1932478542
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 5170 E GLENN ST SUITE 170
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City | TUCSON
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State | AZ
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Zip | 85712-1396
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Country | US
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Telephone | 520-320-9004
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Fax | 520-325-3726
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Provider Business Mailing Address
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Address Line | 5170 E. GLENN STREET SUITE 170
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City | TUCSON
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-320-9004
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Fax | 520-325-3726
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Authorized Official
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Title or Position | DENTISTI/CO-OWNER
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Name | TUAN-ANH MINH NGUYEN
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Credential | DMD
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Telephone | 520-320-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5614
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License Number State | AZ
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