Provider Demographics
NPI:1174916902
Name:TAN BINH NGUYEN, DDS II, PLLC
Entity type:Organization
Organization Name:TAN BINH NGUYEN, DDS II, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN BINH
Authorized Official - Middle Name:PHAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-761-2457
Mailing Address - Street 1:2413 THORNGROVE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4099
Mailing Address - Country:US
Mailing Address - Phone:910-263-8034
Mailing Address - Fax:
Practice Address - Street 1:5511 RAEFORD RD STE 225
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2060
Practice Address - Country:US
Practice Address - Phone:910-485-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918338Medicaid