Provider Demographics
NPI:1225889975
Name:NGUYEN, DANIEL PHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PHAN
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 1:13376 SE SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7534
Mailing Address - Country:US
Mailing Address - Phone:503-454-1999
Mailing Address - Fax:
Practice Address - Street 1:13180 SE 172ND AVE STE 146
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-9654
Practice Address - Country:US
Practice Address - Phone:503-353-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist