Provider Demographics
NPI:1033237656
Name:MINHLY DUY NGUYEN DDS PA
Entity Type:Organization
Organization Name:MINHLY DUY NGUYEN DDS PA
Other - Org Name:FIVE STAR DENTISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINHLY
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-431-8909
Mailing Address - Street 1:12125 HIGHWAY 6 STE D
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8844
Mailing Address - Country:US
Mailing Address - Phone:281-431-8909
Mailing Address - Fax:281-431-8985
Practice Address - Street 1:12125 HIGHWAY 6 STE D
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8844
Practice Address - Country:US
Practice Address - Phone:281-431-8909
Practice Address - Fax:281-431-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161994211Medicaid
TX161994211Medicaid