MEDICARE: VICTORIA NGUYEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37852	TX

General Provider Information

NPI Number	:	1225707839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA NGUYEN DMD

Provider Business Mailing Address
First Line	:	9604 TEN GALLON DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2186
Country	:	US
Telephone Number	:	817-803-4362
Fax Number	:	817-803-4090

Provider Business Practice Location Address
First Line	:	9604 TEN GALLON DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2186
Country	:	US
Telephone Number	:	817-803-4362
Fax Number	:	817-803-4090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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Directions to “ VICTORIA NGUYEN DMD” Practice Location

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