Provider Demographics
NPI:1164645446
Name:NGUYEN, CECILE (DDS)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:
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 1:2700 W UNIVERSITY DR
Mailing Address - Street 2:STE 1060
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1607
Mailing Address - Country:US
Mailing Address - Phone:940-382-5900
Mailing Address - Fax:940-382-5995
Practice Address - Street 1:817 W PIONEER PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4710
Practice Address - Country:US
Practice Address - Phone:972-602-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179602101Medicaid