Provider Demographics
NPI:1104041250
Name:NGUYEN, LAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:THI-XUAN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2105 WOODS CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5198
Mailing Address - Country:US
Mailing Address - Phone:281-922-0330
Mailing Address - Fax:
Practice Address - Street 1:1205 CLEAR LAKE CITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8105
Practice Address - Country:US
Practice Address - Phone:281-488-1477
Practice Address - Fax:281-286-2149
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist