Provider Demographics
NPI:1093232639
Name:NGUYEN, PHUONG THIBICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:THIBICH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3212
Mailing Address - Country:US
Mailing Address - Phone:832-335-6695
Mailing Address - Fax:
Practice Address - Street 1:400 N TIMBERLAND DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0460
Practice Address - Country:US
Practice Address - Phone:936-465-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice