MEDICARE: DR. RYAN 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	2025020809	MO

General Provider Information

NPI Number	:	1427748953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN NGUYEN DMD

Provider Business Mailing Address
First Line	:	6027 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3608
Country	:	US
Telephone Number	:	314-773-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	6027 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3608
Country	:	US
Telephone Number	:	314-773-3666
Fax Number	:

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

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	02/10/2026

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