Provider Demographics
NPI:1780772194
Name:NGUYEN, LONG (DMD)
Entity type:Individual
Prefix:DR
First Name:LONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 S. COLLINS ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018
Mailing Address - Country:US
Mailing Address - Phone:817-419-9009
Mailing Address - Fax:817-419-3377
Practice Address - Street 1:4935 S. COLLINS ST
Practice Address - Street 2:STE 201
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018
Practice Address - Country:US
Practice Address - Phone:817-419-9009
Practice Address - Fax:817-419-3377
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice