Provider Demographics
NPI:1851276182
Name:NGUYEN, DENNIS V (RD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 S 400 W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4545
Mailing Address - Country:US
Mailing Address - Phone:208-690-0357
Mailing Address - Fax:
Practice Address - Street 1:7312 S 400 W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4545
Practice Address - Country:US
Practice Address - Phone:208-690-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2571235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered