MEDICARE: TANIA DUC 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	1223G0001X	General Practice Dentistry	D6798	AZ

General Provider Information

NPI Number	:	1518019595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA DUC NGUYEN DDS

Provider Business Mailing Address
First Line	:	7600 NORTH 15TH STREET
Second Line	:	170
City	:	PHOENIX
State	:	AZ
Zip	:	85020
Country	:	US
Telephone Number	:	602-870-1223
Fax Number	:	602-997-4951

Provider Business Practice Location Address
First Line	:	8910 NORTH 43RD AVE
Second Line	:	104
City	:	GLENDALE
State	:	AZ
Zip	:	85302
Country	:	US
Telephone Number	:	623-939-5131
Fax Number	:	623-939-5361

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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