MEDICARE: DR. ANH PHUONG NGUYEN DDS

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	0401418981	VA

General Provider Information

NPI Number	:	1174365407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANH PHUONG NGUYEN DDS

Provider Business Mailing Address
First Line	:	7089A MECHANICSVILLE TPKE
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3609
Country	:	US
Telephone Number	:	804-417-7788
Fax Number	:	804-417-7789

Provider Business Practice Location Address
First Line	:	7089A MECHANICSVILLE TPKE
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3609
Country	:	US
Telephone Number	:	804-417-7788
Fax Number	:

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

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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