Provider Demographics
NPI:1144813510
Name:NICK NGUYEN DDS LLC
Entity type:Organization
Organization Name:NICK NGUYEN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUC TRUNG
Authorized Official - Middle Name:TRUNG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-658-2383
Mailing Address - Street 1:1016 WOLF RUN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6601
Mailing Address - Country:US
Mailing Address - Phone:470-232-3168
Mailing Address - Fax:
Practice Address - Street 1:55 FREEDOM PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1996
Practice Address - Country:US
Practice Address - Phone:706-658-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental