Provider Demographics
NPI:1770655193
Name:NGUYEN, HIEP (DDS)
Entity type:Individual
Prefix:DR
First Name:HIEP
Middle Name:
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 1:723 A SHOTWELL STREET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020
Mailing Address - Country:US
Mailing Address - Phone:713-670-8922
Mailing Address - Fax:713-670-7969
Practice Address - Street 1:723 A SHOTWELL STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020
Practice Address - Country:US
Practice Address - Phone:713-670-8922
Practice Address - Fax:713-670-7969
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21009122300000X
CA45508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154958601Medicaid