Individual provider Active NPI

Bao-Loan Nguyen, DDS

  • General Practice Dentistry
  • Oklahoma City, OK
National Provider Identifier
1679635551
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5645 Issued in OK
Practice address
2128 SW 74TH St
Oklahoma City, OK 73159-3932
Phone
(405) 682-9988
Fax
(405) 842-9954
NPI assigned
Dec 15, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 5645 OK Primary

Addresses

Primary practice location

2128 SW 74TH St
Oklahoma City, OK 73159-3932

Mailing address

4801 Richmond SQ
Oklahoma City, OK 73118-2058
Phone (405) 840-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20160518001869 OK Order and Referring Only - DentistPractitioner - Dentist 6507155330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5645OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oklahoma Dental-South General Practice Past Accepting new patients
Oklahoma Dental-Yukon General Practice Past Accepting new patients
Oklahoma Dental General Practice Past Accepting new patients
Oklahoma Dental-del City General Practice Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679635551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 RICHMOND SQ",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731182058",
            "telephone_number": "405-840-5600",
            "fax_number": "405-842-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2128 SW 74TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731593932",
            "telephone_number": "405-682-9988",
            "fax_number": "405-842-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "BAO-LOAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.