Provider Demographics
NPI:1902050446
Name:NGUYEN, LAN NGUYET (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:NGUYET
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E ONTARIO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3507
Mailing Address - Country:US
Mailing Address - Phone:951-898-9966
Mailing Address - Fax:928-833-9966
Practice Address - Street 1:260 E ONTARIO AVE STE 203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3507
Practice Address - Country:US
Practice Address - Phone:951-898-9966
Practice Address - Fax:928-833-9966
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist