Provider Demographics
NPI:1760221048
Name:LOAN MAI NGUYEN DDS INC
Entity type:Organization
Organization Name:LOAN MAI NGUYEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-270-3333
Mailing Address - Street 1:1816 TULLY RD STE 243
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4405
Mailing Address - Country:US
Mailing Address - Phone:408-270-3333
Mailing Address - Fax:
Practice Address - Street 1:1816 TULLY RD STE 243
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4405
Practice Address - Country:US
Practice Address - Phone:408-270-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty