Provider Demographics
NPI:1285859090
Name:NGUYEN, VAN VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:VIVIAN
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 1:3404 BEAVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3124
Mailing Address - Country:US
Mailing Address - Phone:817-657-2818
Mailing Address - Fax:
Practice Address - Street 1:1920 W ELDORADO PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7962
Practice Address - Country:US
Practice Address - Phone:817-657-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice