Provider Demographics
NPI:1518262054
Name:NGUYEN, VAN THANH (DDS)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:THANH
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 1:2171 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5484
Mailing Address - Country:US
Mailing Address - Phone:972-235-3999
Mailing Address - Fax:469-640-2623
Practice Address - Street 1:2171 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5484
Practice Address - Country:US
Practice Address - Phone:972-235-3999
Practice Address - Fax:469-640-2623
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597731223G0001X
TX263591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice