Provider Demographics
NPI:1568615870
Name:NGUYEN, LAN MAI (DDS)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:MAI
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 1:2235 CARTER DR STE 109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-0213
Mailing Address - Country:US
Mailing Address - Phone:817-461-5510
Mailing Address - Fax:
Practice Address - Street 1:2235 CARTER DR STE 109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-0213
Practice Address - Country:US
Practice Address - Phone:817-461-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009468201Medicaid