Provider Demographics
NPI:1083821227
Name:NGUYEN, TRUC D (RDH BS)
Entity Type:Individual
Prefix:
First Name:TRUC
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W PLEASANT RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4501
Mailing Address - Country:US
Mailing Address - Phone:817-454-7568
Mailing Address - Fax:
Practice Address - Street 1:821 N FIELDER ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-461-3861
Practice Address - Fax:817-548-7099
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9600124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist