Provider Demographics
NPI:1023682119
Name:NGUYEN, PAUL VAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 TUDO DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-1061
Mailing Address - Country:US
Mailing Address - Phone:504-473-3381
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHWAY 190 STE 4
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5083
Practice Address - Country:US
Practice Address - Phone:985-893-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist