Provider Demographics
NPI:1962667774
Name:NGUYEN, TONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
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 1:2815 AZLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5106
Mailing Address - Country:US
Mailing Address - Phone:817-624-0222
Mailing Address - Fax:817-624-0221
Practice Address - Street 1:2815 AZLE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-5106
Practice Address - Country:US
Practice Address - Phone:817-624-0222
Practice Address - Fax:817-624-0221
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist