Provider Demographics
NPI:1922431519
Name:MTK DENTISTRY, PLLC
Entity Type:Organization
Organization Name:MTK DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:TRUNG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-502-5128
Mailing Address - Street 1:4014 MUSTANG AVE
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4270
Mailing Address - Country:US
Mailing Address - Phone:214-502-5128
Mailing Address - Fax:
Practice Address - Street 1:743 BRICK ROW DR STE 220
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4947
Practice Address - Country:US
Practice Address - Phone:214-502-5128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty