Provider Demographics
NPI:1013995505
Name:NGUYEN, JOHNIE M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHNIE
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 1:1121 FLOWER MOUND RD STE 500
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3251
Mailing Address - Country:US
Mailing Address - Phone:972-355-8568
Mailing Address - Fax:
Practice Address - Street 1:1020 FLOWER MOUND RD STE 110
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3440
Practice Address - Country:US
Practice Address - Phone:972-355-8568
Practice Address - Fax:972-355-8596
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184561223G0001X
NC77221223G0001X
TX225851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190019302Medicaid
BN9830236OtherFEDERAL DEA
BN8301296OtherFEDERAL DEA