Provider Demographics
NPI:1538208426
Name:NGUYEN, MINH T (DDS)
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:T
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 1:1151 E HOLT AVE STE R
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5828
Mailing Address - Country:US
Mailing Address - Phone:909-620-8288
Mailing Address - Fax:
Practice Address - Street 1:1151 E HOLT AVE STE R
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5828
Practice Address - Country:US
Practice Address - Phone:909-620-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB339631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice