MEDICARE: JESSICA ANN 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	122300000X	Dentist	28118	FL

General Provider Information

NPI Number	:	1215611967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN NGUYEN DMD

Provider Business Mailing Address
First Line	:	7529 COLONY LAKE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1305
Country	:	US
Telephone Number	:	561-306-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 BAYSIDE LAKES BLVD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6894
Country	:	US
Telephone Number	:	321-722-0155
Fax Number	:

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

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/24/2026

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