Provider Demographics
NPI:1144300963
Name:NGUYEN, NAM T (DDS)
Entity type:Individual
Prefix:DR
First Name:NAM
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 STEVENS CREEK BLVD APT 171
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-7619
Mailing Address - Country:US
Mailing Address - Phone:408-242-8027
Mailing Address - Fax:
Practice Address - Street 1:5636 STEVENS CREEK BLVD APT 171
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-7619
Practice Address - Country:US
Practice Address - Phone:408-242-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND8218122300000X
CA578951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist