Provider Demographics
NPI:1659000792
Name:NGHIEM, DANIELLE VI
Entity Type:Individual
Prefix:
First Name:DANIELLE VI
Middle Name:
Last Name:NGHIEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 PIKES PEAK
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1750
Mailing Address - Country:US
Mailing Address - Phone:209-879-3039
Mailing Address - Fax:
Practice Address - Street 1:1436 PIKES PEAK
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1750
Practice Address - Country:US
Practice Address - Phone:209-879-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice