Provider Demographics
NPI:1811443252
Name:NGUYEN, JOHN C (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E ALLUVIAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3832
Mailing Address - Country:US
Mailing Address - Phone:559-298-3800
Mailing Address - Fax:559-298-5936
Practice Address - Street 1:1515 E ALLUVIAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3832
Practice Address - Country:US
Practice Address - Phone:559-298-3800
Practice Address - Fax:559-298-5936
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1010501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice