Provider Demographics
NPI:1609925775
Name:NGUYEN, LAN TUAN (DDS)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:TUAN
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 1:4600 I 40 WEST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-354-8525
Mailing Address - Fax:806-353-0089
Practice Address - Street 1:4600 I 40 WEST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-354-8526
Practice Address - Fax:806-353-0089
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist