1154725612 NPI number — 29 PALMS DENTAL GROUP, AN NGUYEN DDS MS CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154725612 NPI number — 29 PALMS DENTAL GROUP, AN NGUYEN DDS MS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
29 PALMS DENTAL GROUP, AN NGUYEN DDS MS CORP
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:
1154725612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73666 JOSHUA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWENTYNINE PALMS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92277-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-865-0544
Provider Business Mailing Address Fax Number:
888-877-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73666 JOSHUA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-865-0544
Provider Business Practice Location Address Fax Number:
888-877-5510
Provider Enumeration Date:
10/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
AN
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-865-0544

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com