MEDICARE: DR. HUYEN 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	1223G0001X	General Practice Dentistry	35453	TX
2	1223G0001X	General Practice Dentistry	D011947	AZ

General Provider Information

NPI Number	:	1235781303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUYEN NGUYEN DMD

Provider Business Mailing Address
First Line	:	PO BOX 642
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85380-0642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21050 N TATUM BLVD STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4262
Country	:	US
Telephone Number	:	480-400-1794
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	09/18/2025

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