Individual
BAO LOU NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2150 N WATERMAN AVE, STE 103, SAN BERNARDINO, CA 92404-4811
(909) 882-7974
(909) 713-0192
Mailing address
2150 N WATERMAN AVE, STE 103, SAN BERNARDINO, CA 92404-4811
(909) 882-7974
(909) 713-0192
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
42378
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BN4237801
—
CA
Enumeration date
08/17/2006
Last updated
07/08/2007
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