Provider Demographics
NPI:1497894919
Name:NGUYEN, CORY NHUT (DDS)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:NHUT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N INTERNATIONAL RD STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6515
Mailing Address - Country:US
Mailing Address - Phone:972-276-7300
Mailing Address - Fax:972-276-7373
Practice Address - Street 1:13655 PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4783
Practice Address - Country:US
Practice Address - Phone:214-357-6100
Practice Address - Fax:972-276-7373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201351108Medicaid
TX473523095OtherTAX ID