1265503940 NPI number — VICKY NGUYEN DDS PC

Table of content: (NPI 1265503940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265503940 NPI number — VICKY NGUYEN DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICKY NGUYEN DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265503940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
969 WINDY HILL ROAD
Provider Second Line Business Mailing Address:
SUITE J
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-431-9578
Provider Business Mailing Address Fax Number:
770-438-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
969 WINDY HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-431-9578
Provider Business Practice Location Address Fax Number:
770-438-2919
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
VICKY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT DENTIST
Authorized Official Telephone Number:
770-431-9578

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN011814 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 44962 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100488 . This is a "AVESIS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 108026 . This is a "DORAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 9180328 . This is a "DORAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00802194B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166402 . This is a "DORAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 39274 . This is a "AVESIS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com