Provider Demographics
NPI:1740702075
Name:NGUYEN, LANDON LONG (DDS)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:LONG
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 1:5500 STATE HIGHWAY 121 APT 721
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4289
Mailing Address - Country:US
Mailing Address - Phone:714-336-6229
Mailing Address - Fax:
Practice Address - Street 1:245 E GRAUWYLER RD STE 109
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2635
Practice Address - Country:US
Practice Address - Phone:214-596-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37969OtherTEXAS STATE BOARD OF DENTAL EXAMINERS