MEDICARE: AFFORDABLE DENTURES - CANTON, VICTOR H. NGUYEN, DMD, INC.

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	30.023545	OH

General Provider Information

NPI Number	:	1649636242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - CANTON, VICTOR H. NGUYEN, DMD, INC.

Provider Business Mailing Address
First Line	:	2737 MARET ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-3909
Country	:	US
Telephone Number	:	330-451-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 MARET ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-3909
Country	:	US
Telephone Number	:	330-451-2205
Fax Number	:

Authorized Official
Title or Position	:	DMD/PRACTICE OWNER
Name	:	VICTOR NGUYEN
Credential	:
Telephone Number	:	330-451-2205

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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