MEDICARE: DR. AMELIE NGUYEN D.D.S

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	122300000X	Dentist	62913	CA
2	1223G0001X	General Practice Dentistry	DN22910	FL

General Provider Information

NPI Number	:	1114352176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMELIE NGUYEN D.D.S

Provider Business Mailing Address
First Line	:	5316 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-8772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-8772
Country	:	US
Telephone Number	:	407-239-9557
Fax Number	:

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

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	08/17/2017

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