Provider Demographics
NPI:1376713602
Name:QUYNH G. NGUYEN D.D.S., P.C.
Entity Type:Organization
Organization Name:QUYNH G. NGUYEN D.D.S., P.C.
Other - Org Name:Q DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYNH
Authorized Official - Middle Name:G
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:281-261-0575
Mailing Address - Street 1:867 DULLES AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5705
Mailing Address - Country:US
Mailing Address - Phone:281-261-0575
Mailing Address - Fax:281-261-2698
Practice Address - Street 1:867 DULLES AVE
Practice Address - Street 2:SUITE F
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5705
Practice Address - Country:US
Practice Address - Phone:281-261-0575
Practice Address - Fax:281-261-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0907297020Medicaid
TX346296OtherUNITED CONCORDIA
TX86D663OtherBCBS
TX0012427OtherASSURANT