Provider Demographics
NPI:1295992675
Name:NGUYEN, SY DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SY
Middle Name:DAN
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 1:3225 N GRAPEVINE MILLS BLVD
Mailing Address - Street 2:APT 2225
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0971
Mailing Address - Country:US
Mailing Address - Phone:614-209-6859
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist