Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D-0006787-C1 | AL |
NPI | 1003424250 |
---|---|
Provider Name | Hung Nguyen |
First Address | Prattville, AL 36066-7899 |
Second Address | Prattville, AL 36066-7899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |