Provider Demographics
NPI:1457577306
Name:NGUYEN, JONATHAN THIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THIEN
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 1:8021 MATLOCK RD,
Mailing Address - Street 2:SUITE #123
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4707
Mailing Address - Country:US
Mailing Address - Phone:817-472-9495
Mailing Address - Fax:817-472-9428
Practice Address - Street 1:8021 MATLOCK RD
Practice Address - Street 2:SUITE #123
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4707
Practice Address - Country:US
Practice Address - Phone:817-472-9495
Practice Address - Fax:817-472-9428
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist