| Tustin Village Dental | |
|
14521 Red Hill Ave Tustin CA 92780 | |
| (714) 838-9912 | |
| (714) 838-9913 |
| Full Name | Tustin Village Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 14521 Red Hill Ave, Tustin, California |
| Authorized Official Name and Position | Elizabeth K Nguyen (DDS) |
| Authorized Official Contact | 7148389912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tustin Village Dental 14521 Red Hill Ave Tustin CA 92780-6238 Ph: (714) 838-9912 | Tustin Village Dental 14521 Red Hill Ave Tustin CA 92780 Ph: (714) 838-9912 |
| NPI Number | 1346733573 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 10/18/2019 |
| Medicare PECOS PAC ID | 6002248259 |
|---|---|
| Medicare Enrollment ID | O20191110000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346733573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 52762 (California) | Primary |
| Provider Name | Elizabeth Kim Nguyen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1033202726 PECOS PAC ID: 2466884614 Enrollment ID: I20191110000011 |
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