Active NPI
Deric Nguyen, DDS
- Dentist
- Santa Rosa, CA
National Provider Identifier
1164260568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS112460
- Practice address
- 3462 Mendocino Ave
Santa Rosa, CA 95403-2214 - Phone
- (707) 508-7095
- NPI assigned
- Jul 18, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS112460 | CA | Primary |
Addresses
Primary practice location
3462 Mendocino Ave
Santa Rosa, CA 95403-2214
Mailing address
3462 Mendocino Ave
Santa Rosa, CA 95403-2214
Phone (707) 508-7095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS112460 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762387200000",
"number": "1164260568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3462 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032214",
"telephone_number": "707-508-7095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3462 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032214",
"telephone_number": "707-508-7095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "DERIC",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-18",
"last_updated": "2025-11-06",
"certification_date": "2025-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS112460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.