Provider Demographics
NPI:1730243684
Name:NGHIEM, FRANK T (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:T
Last Name:NGHIEM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:T
Other - Last Name:NGHIEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1510 DORCHESTER AVE
Mailing Address - Street 2:1510 DORCHESTER AVE
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1327
Mailing Address - Country:US
Mailing Address - Phone:617-288-7600
Mailing Address - Fax:
Practice Address - Street 1:1510 DORCHESTER AVE
Practice Address - Street 2:1510 DORCHESTER AVE
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1327
Practice Address - Country:US
Practice Address - Phone:617-288-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0266795Medicaid