Provider Demographics
NPI:1770796526
Name:NGUYEN, TRUNG QUANG (DDS)
Entity type:Individual
Prefix:
First Name:TRUNG
Middle Name:QUANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ARTHUR
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1313 BRIARCREST DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5232
Mailing Address - Country:US
Mailing Address - Phone:979-776-4364
Mailing Address - Fax:979-776-4360
Practice Address - Street 1:1313 BRIARCREST DR
Practice Address - Street 2:SUITE D
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5232
Practice Address - Country:US
Practice Address - Phone:979-776-4364
Practice Address - Fax:979-776-4360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090467403Medicaid