Provider Demographics
NPI:1043204589
Name:NGUYEN, DAN X (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:X
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 VICTORIA PARK LN
Mailing Address - Street 2:STE 3A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1850
Mailing Address - Country:US
Mailing Address - Phone:909-463-4190
Mailing Address - Fax:
Practice Address - Street 1:7270 VICTORIA PARK LN
Practice Address - Street 2:STE 3A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-1850
Practice Address - Country:US
Practice Address - Phone:909-463-4190
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice