Provider Demographics
NPI:1831476522
Name:NGUYEN, MONALISA CECILIA (DDS)
Entity Type:Individual
Prefix:
First Name:MONALISA
Middle Name:CECILIA
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 1:1533 N SHEPHERD DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3755
Mailing Address - Country:US
Mailing Address - Phone:832-303-9390
Mailing Address - Fax:
Practice Address - Street 1:1533 N SHEPHERD DR STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3755
Practice Address - Country:US
Practice Address - Phone:832-303-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27208122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist