MEDICARE: DR. HIEP PHUC 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	1223G0001X	General Practice Dentistry	22DI01831600	NJ

General Provider Information

NPI Number	:	1952393449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIEP PHUC NGUYEN DMD

Provider Business Mailing Address
First Line	:	3805 VENTNOR AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-5944
Country	:	US
Telephone Number	:	609-572-0680
Fax Number	:	609-572-0696

Provider Business Practice Location Address
First Line	:	3805 VENTNOR AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-5944
Country	:	US
Telephone Number	:	609-572-0680
Fax Number	:	609-572-0696

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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