Provider Demographics
NPI:1477668457
Name:FERNANDEZ, THANH NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:NGUYEN
Last Name:FERNANDEZ
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 1:16711 FALLEN TREE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2036
Mailing Address - Country:US
Mailing Address - Phone:972-375-7519
Mailing Address - Fax:
Practice Address - Street 1:1815 SOUTH FIRST STREET
Practice Address - Street 2:SUITE H
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-271-4500
Practice Address - Fax:972-271-4511
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174133210Medicaid