Provider Demographics
NPI:1649591140
Name:NGUYEN, PHONG LAN (DDS)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:LAN
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 1:2334 W BUCKINGHAM RD STE 260
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3913
Mailing Address - Country:US
Mailing Address - Phone:469-298-2157
Mailing Address - Fax:
Practice Address - Street 1:2334 W BUCKINGHAM RD STE 260
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3913
Practice Address - Country:US
Practice Address - Phone:469-298-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist