Provider Demographics
NPI:1871265777
Name:NGUON, DESTIN SOKEYNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESTIN
Middle Name:SOKEYNA
Last Name:NGUON
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 1:8638 HUEBNER RD APT 2440
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2476
Mailing Address - Country:US
Mailing Address - Phone:936-537-7300
Mailing Address - Fax:
Practice Address - Street 1:12175 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2334
Practice Address - Country:US
Practice Address - Phone:210-681-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist