Provider Demographics
NPI:1174365407
Name:NGUYEN, ANH PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7089A MECHANICSVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3609
Mailing Address - Country:US
Mailing Address - Phone:804-417-7788
Mailing Address - Fax:804-417-7789
Practice Address - Street 1:7089A MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3609
Practice Address - Country:US
Practice Address - Phone:804-417-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice