Provider Demographics
NPI:1780877357
Name:NGUYEN, AN THI (DDS, MPH)
Entity type:Individual
Prefix:
First Name:AN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:AN
Other - Middle Name:T
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MPH
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-665-3397
Practice Address - Street 1:8990 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4537
Practice Address - Country:US
Practice Address - Phone:720-929-1656
Practice Address - Fax:720-565-4129
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000098641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82022747Medicaid