Provider Demographics
NPI:1356869218
Name:REYNA NGUYEN D.D.S P.L.L.C
Entity type:Organization
Organization Name:REYNA NGUYEN D.D.S P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-729-0300
Mailing Address - Street 1:2770 AERO DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1519
Mailing Address - Country:US
Mailing Address - Phone:409-729-0300
Mailing Address - Fax:409-729-0319
Practice Address - Street 1:2770 AERO DR
Practice Address - Street 2:STE 2
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77604
Practice Address - Country:US
Practice Address - Phone:409-729-0300
Practice Address - Fax:409-729-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty