MEDICARE: DR. PETER PHUOC 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	122300000X	Dentist	5995	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841289188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PHUOC NGUYEN DMD

Provider Business Mailing Address
First Line	:	2220 W APACHE RAIN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5086
Country	:	US
Telephone Number	:	623-907-9334
Fax Number	:

Provider Business Practice Location Address
First Line	:	7435 W LOWER BUCKEYE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7636
Country	:	US
Telephone Number	:	623-907-9334
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	04/09/2013

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