MEDICARE: DR. HOANG THAI NGUYEN DDS, MS

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	9021	CO
2	1223P0300X	Periodontics	9021	CO
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9021	CO

General Provider Information

NPI Number	:	1740479252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOANG THAI NGUYEN DDS, MS

Provider Business Mailing Address
First Line	:	1344 S CHAMBERS RD
Second Line	:	SUITE 104
City	:	AURORA
State	:	CO
Zip	:	80017-4096
Country	:	US
Telephone Number	:	303-337-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 S CHAMBERS RD
Second Line	:	SUITE 104
City	:	AURORA
State	:	CO
Zip	:	80017-4096
Country	:	US
Telephone Number	:	303-337-2999
Fax Number	:

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

Provider Enumeration Date	:	10/20/2007
Last Update Date	:	09/22/2009

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