Provider Demographics
NPI:1609258698
Name:NGUYEN, ALVIN
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 NW 84TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1547
Mailing Address - Country:US
Mailing Address - Phone:832-729-5582
Mailing Address - Fax:
Practice Address - Street 1:12711 NARCOOSSEE RD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6991
Practice Address - Country:US
Practice Address - Phone:407-627-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0404931223G0001X
FLDN238371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice