Provider Demographics
NPI:1861875866
Name:NGUYEN, MICHELE LY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LY
Last Name:NGUYEN
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 1:233 SCHERMERHORN ST APT 9B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5874
Mailing Address - Country:US
Mailing Address - Phone:504-231-3923
Mailing Address - Fax:
Practice Address - Street 1:185 MONTAGUE ST STE 9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3637
Practice Address - Country:US
Practice Address - Phone:718-638-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics