Provider Demographics
NPI:1568959435
Name:NGUYEN, LUAT HUU (DDS)
Entity Type:Individual
Prefix:
First Name:LUAT
Middle Name:HUU
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 1:4500 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-6620
Mailing Address - Country:US
Mailing Address - Phone:214-762-1809
Mailing Address - Fax:
Practice Address - Street 1:1151 E US HIGHWAY 377 STE 101
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-4009
Practice Address - Country:US
Practice Address - Phone:817-203-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice