Individual provider Active NPI

Dzung B. Nguyen, DMD

  • General Practice Dentistry
  • Deland, FL
National Provider Identifier
1093775280
Registry record updated Apr 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN14906 Issued in FL
Practice address
2641 S Woodland Blvd
Deland, FL 32720-8601
Phone
(386) 738-7441
Fax
(386) 738-1299
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN14906 FL Primary

Addresses

Primary practice location

2641 S Woodland Blvd
Deland, FL 32720-8601

Mailing address

926 Great Pond Dr
Suite 2003
Altamonte Springs, FL 32714-7244
Phone (407) 772-5124

Other identifiers 1

IdentifierTypeStateIssuer
001039300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150619001188 FL Order and Referring Only - DentistPractitioner - Dentist 1658682414

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN14906FLMDGeneral Practice Dentistry

Networks

  • Freedom Health HMO Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272240000000",
    "number": "1093775280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 GREAT POND DR",
            "address_2": "SUITE 2003",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327147244",
            "telephone_number": "407-772-5124",
            "fax_number": "407-788-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 S WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327208601",
            "telephone_number": "386-738-7441",
            "fax_number": "386-738-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DZUNG",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2010-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001039300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.