Provider Demographics
NPI:1538261276
Name:TUAN M NGUYEN DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TUAN M NGUYEN DDS PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPOUSE CO OWNER SEC OF CORP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOMINGO-NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-634-2024
Mailing Address - Street 1:473 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENACINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-634-2024
Mailing Address - Fax:760-634-7970
Practice Address - Street 1:473 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENACINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-634-2024
Practice Address - Fax:760-634-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA43333122300000X
CACA42750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty