MEDICARE: DR. TUYEN VAN NGUYEN D.D.S.

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	D11658	MN

General Provider Information

NPI Number	:	1295888428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUYEN VAN NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	1652 116TH AVE NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-4661
Country	:	US
Telephone Number	:	763-786-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 ELIOT AVE.
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069-0643
Country	:	US
Telephone Number	:	320-358-4733
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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