Provider Demographics
NPI:1376618058
Name:NGUYEN, CUONG HUU (DDS)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:HUU
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 1:9865 BLACKHAWK BLVD
Mailing Address - Street 2:SUITE #E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075
Mailing Address - Country:US
Mailing Address - Phone:713-987-5300
Mailing Address - Fax:713-987-5302
Practice Address - Street 1:9865 BLACKHAWK BLVD
Practice Address - Street 2:SUITE #E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075
Practice Address - Country:US
Practice Address - Phone:713-987-5300
Practice Address - Fax:713-987-5302
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175485501Medicaid