MEDICARE: CHRISTINE DO TRAN 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN1860003	MA

General Provider Information

NPI Number	:	1528848603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE DO TRAN NGUYEN DMD

Provider Business Mailing Address
First Line	:	70 PARKER HILL AVE APT 606
Second Line	:
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-3295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 WILLIAM S CANNING BLVD
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02721-2338
Country	:	US
Telephone Number	:	508-403-5872
Fax Number	:

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

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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