Provider Demographics
NPI:1700226651
Name:NGUYEN, JIMMY U (DDS)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:U
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 1:610 N WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-6314
Mailing Address - Country:US
Mailing Address - Phone:504-491-5363
Mailing Address - Fax:
Practice Address - Street 1:4605 W BAILEY BOSWELL RD STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4327
Practice Address - Country:US
Practice Address - Phone:682-250-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice