Provider Demographics
NPI:1053608729
Name:NGUYEN, NGOC AN KHANH (DMD)
Entity type:Individual
Prefix:MS
First Name:NGOC AN
Middle Name:KHANH
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 1:3021 LEILA ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5306
Mailing Address - Country:US
Mailing Address - Phone:502-640-5959
Mailing Address - Fax:
Practice Address - Street 1:4021 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1623
Practice Address - Country:US
Practice Address - Phone:863-837-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9082122300000X
FLDN284781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist