Provider Demographics
NPI:1376898163
Name:NGUYEN, QUYEN LE (DDS)
Entity Type:Individual
Prefix:
First Name:QUYEN
Middle Name:LE
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 1:11011 DOMAIN DR
Mailing Address - Street 2:APT 11343
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7764
Mailing Address - Country:US
Mailing Address - Phone:361-463-9861
Mailing Address - Fax:
Practice Address - Street 1:940 PAYTON GIN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6720
Practice Address - Country:US
Practice Address - Phone:512-834-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice