Provider Demographics
NPI:1962506345
Name:NGUYEN, PHUONG M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:M
Last Name:NGUYEN
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 1:1120 E PIONEER PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6496
Mailing Address - Country:US
Mailing Address - Phone:817-461-3540
Mailing Address - Fax:817-303-8046
Practice Address - Street 1:1120 E PIONEER PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6496
Practice Address - Country:US
Practice Address - Phone:817-461-3540
Practice Address - Fax:817-303-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22458-01OtherTX CHIP