Quan Vo Anh Nguyen DDS Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

46658 Issued in CA

Legal business name

QUAN VO ANH NGUYEN DDS INC

Doing business as

Innovation Dental

Practice address

702 Porter Ave Ste F
Stockton, CA 95207-4297

Phone

(209) 478-9648

NPI assigned

May 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Quan Vo Anh Nguyen, DDS

Title

Ceo/ Managing Dentist

Phone

(209) 478-9648

Specialties & licenses 1

Addresses

Other names 1

• Innovation Dental Doing business as

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336089600000",
    "number": "1992064364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 PORTER AVE STE F",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952074297",
            "telephone_number": "209-478-9648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 PORTER AVE STE F",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952074297",
            "telephone_number": "209-478-9648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAN VO ANH NGUYEN DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-05-04",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "QUAN",
        "authorized_official_middle_name": "VO ANH",
        "authorized_official_title_or_position": "CEO/ MANAGING DENTIST",
        "authorized_official_telephone_number": "209-478-9648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovation Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Stockton, CA
• Providers in Stockton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.