Provider Demographics
NPI:1144838863
Name:NGUYEN, MINH TRAM (DMD)
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:TRAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SANDALWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2681
Mailing Address - Country:US
Mailing Address - Phone:253-235-9385
Mailing Address - Fax:
Practice Address - Street 1:405 COOPER POINT RD NW # 103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4437
Practice Address - Country:US
Practice Address - Phone:360-866-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61074502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist