Provider Demographics
NPI:1881829653
Name:HUYNH, QUYEN TU (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:TU
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:QUYEN
Other - Middle Name:TU
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4709 RAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3838
Mailing Address - Country:US
Mailing Address - Phone:469-655-5221
Mailing Address - Fax:
Practice Address - Street 1:3200 S LANCASTER RD STE 183
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4555
Practice Address - Country:US
Practice Address - Phone:214-375-9999
Practice Address - Fax:214-375-9997
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201588506Medicaid