Provider Demographics
NPI:1861692097
Name:SCOTT NGUYEN, DDS, INC.
Entity type:Organization
Organization Name:SCOTT NGUYEN, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-795-9669
Mailing Address - Street 1:6180 JARVIS AVE.
Mailing Address - Street 2:#J
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1200
Mailing Address - Country:US
Mailing Address - Phone:510-795-9669
Mailing Address - Fax:510-795-1404
Practice Address - Street 1:6180 JARVIS AVE.
Practice Address - Street 2:#J
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1200
Practice Address - Country:US
Practice Address - Phone:510-795-9669
Practice Address - Fax:510-795-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty