Provider Demographics
NPI:1295710531
Name:NGUYEN, QUYNH LAN (DMD)
Entity type:Individual
Prefix:DR
First Name:QUYNH
Middle Name:LAN
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 1:5115 HAWTHORNE SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4671
Mailing Address - Country:US
Mailing Address - Phone:281-853-4963
Mailing Address - Fax:713-781-7829
Practice Address - Street 1:5705 FONDREN RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1843
Practice Address - Country:US
Practice Address - Phone:714-781-7827
Practice Address - Fax:713-781-7829
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26347122300000X, 1223G0001X
CA58171122300000X
WADE00011142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2843898-08Medicaid