MEDICARE: DR. PETER N NGUYEN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN14635	FL
2	1223G0001X	General Practice Dentistry	D9919	OR
3	1223G0001X	General Practice Dentistry	DE60390336	WA

General Provider Information

NPI Number	:	1053437731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER N NGUYEN D.M.D.

Provider Business Mailing Address
First Line	:	1436 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4004
Country	:	US
Telephone Number	:	239-776-6728
Fax Number	:	855-631-0407

Provider Business Practice Location Address
First Line	:	1436 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4004
Country	:	US
Telephone Number	:	239-776-6728
Fax Number	:	855-631-0407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/15/2013

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