Provider Demographics
NPI:1447422290
Name:TRONG D. NGUYEN, D.D.S., P.A.
Entity Type:Organization
Organization Name:TRONG D. NGUYEN, D.D.S., P.A.
Other - Org Name:TIDWELL DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRONG
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-691-0555
Mailing Address - Street 1:932 E TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-1826
Mailing Address - Country:US
Mailing Address - Phone:713-691-0555
Mailing Address - Fax:713-691-0921
Practice Address - Street 1:932 E TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-1826
Practice Address - Country:US
Practice Address - Phone:713-691-0555
Practice Address - Fax:713-691-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179391223G0001X
TX230501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126807004Medicaid
TX1952186041Medicaid
TX975552OtherUNITED CONCORDIA
TXTEX60OtherTEXAS CHIP