Provider Demographics
NPI:1730307380
Name:NGUYEN-TU, MAI THI (DDS)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:THI
Last Name:NGUYEN-TU
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 1:20376 E CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4609
Mailing Address - Country:US
Mailing Address - Phone:909-374-0851
Mailing Address - Fax:
Practice Address - Street 1:1922 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5724
Practice Address - Country:US
Practice Address - Phone:909-374-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADENTICAL D31096OtherDENTIST