MEDICARE: DR. DAN THANH LINH 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	390200000X	Student in an Organized Health Care Education/Training Program	13415	CT
2	1223P0221X	Pediatric Dentistry	DN10000037	MA

General Provider Information

NPI Number	:	1992452759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN THANH LINH NGUYEN DMD

Provider Business Mailing Address
First Line	:	52 WILKIN DR
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-2034
Country	:	US
Telephone Number	:	781-654-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2321
Country	:	US
Telephone Number	:	413-525-6626
Fax Number	:

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

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/12/2025

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