MEDICARE: TRUNG THE NGUYEN

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	DN122450	GA

General Provider Information

NPI Number	:	1215600986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUNG THE NGUYEN

Provider Business Mailing Address
First Line	:	3700 MARKET ST STE A2
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-2652
Country	:	US
Telephone Number	:	404-296-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 MARKET ST STE A2
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-2652
Country	:	US
Telephone Number	:	404-296-8877
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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Directions to “ TRUNG THE NGUYEN ” Practice Location

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