MEDICARE: CHI THIEN 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	DN13524	FL

General Provider Information

NPI Number	:	1720170871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHI THIEN NGUYEN DDS

Provider Business Mailing Address
First Line	:	PO BOX 5340
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33571-5340
Country	:	US
Telephone Number	:	813-642-8885
Fax Number	:	813-633-8891

Provider Business Practice Location Address
First Line	:	768 CORTARO DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6811
Country	:	US
Telephone Number	:	813-642-8885
Fax Number	:	813-664-2889

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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