Provider Demographics
NPI:1467160481
Name:NGUYEN, VIVIAN THI
Entity Type:Individual
Prefix:MISS
First Name:VIVIAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:NGUYEN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8036 SUMMER SUN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6032
Mailing Address - Country:US
Mailing Address - Phone:817-586-8170
Mailing Address - Fax:
Practice Address - Street 1:8408 DAVIS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8691
Practice Address - Country:US
Practice Address - Phone:817-586-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist