Provider Demographics
NPI:1053437731
Name:NGUYEN, PETER N (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4004
Mailing Address - Country:US
Mailing Address - Phone:239-776-6728
Mailing Address - Fax:855-631-0407
Practice Address - Street 1:1436 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4004
Practice Address - Country:US
Practice Address - Phone:239-776-6728
Practice Address - Fax:855-631-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146351223G0001X
ORD99191223G0001X
WADE603903361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice