MEDICARE: DR. QUYNH LAN 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	26347	TX
2	122300000X	Dentist	58171	CA
3	122300000X	Dentist	DE00011142	WA
4	1223G0001X	General Practice Dentistry	26347	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295710531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUYNH LAN NGUYEN DMD

Provider Business Mailing Address
First Line	:	5115 HAWTHORNE SPRINGS LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4671
Country	:	US
Telephone Number	:	281-853-4963
Fax Number	:	713-781-7829

Provider Business Practice Location Address
First Line	:	5705 FONDREN RD STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1843
Country	:	US
Telephone Number	:	714-781-7827
Fax Number	:	713-781-7829

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	05/28/2021

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