MEDICARE: DR. DANIEL PHAN 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	122300000X	Dentist	12018	OR

General Provider Information

NPI Number	:	1225889975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL PHAN NGUYEN DDS

Provider Business Mailing Address
First Line	:	13376 SE SCENIC RIDGE DR
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-7534
Country	:	US
Telephone Number	:	503-454-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	13180 SE 172ND AVE STE 146
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-9654
Country	:	US
Telephone Number	:	503-353-6568
Fax Number	:

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

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	07/01/2024

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