1497959159 NPI number — HOADIEP NGUYEN GRAHAM DDS

Table of content: HOADIEP NGUYEN GRAHAM DDS (NPI 1497959159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497959159 NPI number — HOADIEP NGUYEN GRAHAM DDS

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
HOA DIEP
Provider Other Middle Name:
TRAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497959159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2818 NEUSE BLVD
Provider Second Line Business Mailing Address:
CRAVEN COUTY HEALTH DEPT: DENTAL
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-2850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-636-4920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2818 NEUSE BLVD
Provider Second Line Business Practice Location Address:
CRAVEN COUTY HEALTH DEPT: DENTAL
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-636-4920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  150621 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 150621 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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