Provider Demographics
NPI:1730704743
Name:NGUYEN, BAO TRAN KIEU (DMD)
Entity type:Individual
Prefix:DR
First Name:BAO TRAN
Middle Name:KIEU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16511 NORTHCROSS DR STE F
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5021
Mailing Address - Country:US
Mailing Address - Phone:704-987-7996
Mailing Address - Fax:
Practice Address - Street 1:11050 W COLONIAL DR STE 30
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2998
Practice Address - Country:US
Practice Address - Phone:407-284-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN286271223G0001X
NC118961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice