MEDICARE: DR. GABRIELLE D. 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	0011765	GA

General Provider Information

NPI Number	:	1780736819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE D. NGUYEN DDS

Provider Business Mailing Address
First Line	:	1029 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6719
Country	:	US
Telephone Number	:	404-761-1542
Fax Number	:	404-761-1778

Provider Business Practice Location Address
First Line	:	1029 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6719
Country	:	US
Telephone Number	:	404-761-1542
Fax Number	:	404-761-1778

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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