Provider Demographics
NPI:1932460995
Name:NGUYEN, AMY (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5695 KYLE PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6442
Mailing Address - Country:US
Mailing Address - Phone:512-268-0333
Mailing Address - Fax:
Practice Address - Street 1:5695 KYLE PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6442
Practice Address - Country:US
Practice Address - Phone:512-268-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290951223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program