Provider Demographics
NPI:1174760482
Name:NGUYEN, HARRISON (DDS, MSD)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2828
Mailing Address - Country:US
Mailing Address - Phone:925-469-0875
Mailing Address - Fax:
Practice Address - Street 1:5720 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 280
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2828
Practice Address - Country:US
Practice Address - Phone:925-469-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist