Provider Demographics
NPI:1790180974
Name:NGUYEN, ROSALIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 BELLAIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5429
Mailing Address - Country:US
Mailing Address - Phone:281-575-0742
Mailing Address - Fax:
Practice Address - Street 1:10080 BELLAIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5429
Practice Address - Country:US
Practice Address - Phone:281-575-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6502122300000X
TX306061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist