Provider Demographics
NPI:1134675184
Name:NGUYEN, JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 HOLT LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4714
Mailing Address - Country:US
Mailing Address - Phone:903-238-4986
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S STE 650
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2997
Practice Address - Country:US
Practice Address - Phone:713-457-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist