Provider Demographics
NPI:1841339603
Name:NGUYEN, HAIDUONG H (DDS)
Entity type:Individual
Prefix:DR
First Name:HAIDUONG
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 BOAT CLUB RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7022
Mailing Address - Country:US
Mailing Address - Phone:817-238-0321
Mailing Address - Fax:
Practice Address - Street 1:4625 BOAT CLUB RD
Practice Address - Street 2:SUITE 225
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7022
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54941223G0001X
AZ68281223G0001X
TX225931223G0001X
GADN0132401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice