1407329774 NPI number — MANUEL NGUYEN PEDIATRIC DENTISTRY

Table of content: JUDI MOREHEAD MA, QMHP (NPI 1164588067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407329774 NPI number — MANUEL NGUYEN PEDIATRIC DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANUEL NGUYEN PEDIATRIC DENTISTRY
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:
1407329774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
866 SEVEN HILLS DR STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-706-5751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
866 SEVEN HILLS DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-706-5751
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
909-706-5751

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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