MEDICARE: MICHAEL NGUYEN D.D.S., M.S.D.

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	1223P0300X	Periodontics	30047	TX

General Provider Information

NPI Number	:	1417482779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NGUYEN D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	810 S MASON RD STE 325
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3858
Country	:	US
Telephone Number	:	281-392-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S MASON RD STE 325
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3858
Country	:	US
Telephone Number	:	281-392-6000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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