Provider Demographics
NPI:1669620472
Name:BEYOND DENTAL AESTHETICS, P.A.
Entity type:Organization
Organization Name:BEYOND DENTAL AESTHETICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:NHUT
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-867-3553
Mailing Address - Street 1:2524 KENT DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-1737
Mailing Address - Country:US
Mailing Address - Phone:469-867-3553
Mailing Address - Fax:972-276-7373
Practice Address - Street 1:2515 INWOOD RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7434
Practice Address - Country:US
Practice Address - Phone:469-867-3553
Practice Address - Fax:972-276-7373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEYOND DENTAL AESTHETICS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00216861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty