Provider Demographics
NPI:1871104968
Name:NGUYEN, NGOC BAO (DMD)
Entity type:Individual
Prefix:DR
First Name:NGOC
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NGOC
Other - Middle Name:BAO
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:7405 EXMORE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4027
Mailing Address - Country:US
Mailing Address - Phone:703-973-4120
Mailing Address - Fax:
Practice Address - Street 1:3608 FOREST DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1092
Practice Address - Country:US
Practice Address - Phone:703-671-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice