Provider Demographics
NPI:1669025201
Name:NGUYEN, NGHIA THIEN (DDS)
Entity Type:Individual
Prefix:
First Name:NGHIA
Middle Name:THIEN
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 1:2403 N WASHINGTON AVE APT 144
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3728
Mailing Address - Country:US
Mailing Address - Phone:712-204-4777
Mailing Address - Fax:
Practice Address - Street 1:2650 S STATE HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7205
Practice Address - Country:US
Practice Address - Phone:469-203-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty