Provider Demographics
NPI:1104674498
Name:NGUYEN, ANNIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
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:PSC 80 BOX 20466
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0089
Mailing Address - Country:US
Mailing Address - Phone:251-458-9506
Mailing Address - Fax:
Practice Address - Street 1:1065 W PERIMETER ROAD
Practice Address - Street 2:
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:240-612-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002060741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice