Provider Demographics
NPI:1245248343
Name:NGUYEN, JACQUELINE THI (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E FM 544
Mailing Address - Street 2:#100
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4000
Mailing Address - Country:US
Mailing Address - Phone:972-516-2928
Mailing Address - Fax:972-423-4511
Practice Address - Street 1:170 E FM 544
Practice Address - Street 2:#100
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4000
Practice Address - Country:US
Practice Address - Phone:972-516-2928
Practice Address - Fax:972-423-4511
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice