Provider Demographics
NPI:1922412311
Name:SUGAR LAND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SUGAR LAND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-763-9059
Mailing Address - Street 1:4724 SWEETWATER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3150
Mailing Address - Country:US
Mailing Address - Phone:281-565-0808
Mailing Address - Fax:281-494-2404
Practice Address - Street 1:4724 SWEETWATER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3150
Practice Address - Country:US
Practice Address - Phone:281-565-0808
Practice Address - Fax:281-494-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3274821Medicaid