# 1692 TULLY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649406133
- **Authorized official:** MRS. PHUNG KIM NGUYEN (DENTIST)
- **Authorized official phone:** (408) 279-2114

## Contact information

- **Practice address:** 2114 SENIOR ROAD, SUITE 25, SAN JOSE, CA 95112
- **Practice address phone:** (408) 279-2114
- **Practice address fax:** (408) 279-1828
- **Mailing address:** 1692 TULLY ROAD, \#4, SAN JOSE, CA 95122
- **Mailing address phone:** (408) 223-6953
- **Mailing address fax:** (408) 223-0749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 44749 | CA | Yes |

## Other

- **Enumeration date:** 06/10/2009
- **Last updated:** 06/10/2009