MEDICARE: DR. JUDY NGUYEN DMD

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	11249	SC
2	1223P0221X	Pediatric Dentistry	D011102	AZ

General Provider Information

NPI Number	:	1194397927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY NGUYEN DMD

Provider Business Mailing Address
First Line	:	2811 E SAN TAN ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-4074
Country	:	US
Telephone Number	:	480-358-7372
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2833
Country	:	US
Telephone Number	:	770-692-1000
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	03/17/2026

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