MEDICARE: HIEN THANH NGUYEN D.D.S.

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	19370	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	978970	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1518034818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIEN THANH NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	7608 W MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-1928
Country	:	US
Telephone Number	:	210-645-0000
Fax Number	:	210-673-3616

Provider Business Practice Location Address
First Line	:	7608 W MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-1928
Country	:	US
Telephone Number	:	210-645-0000
Fax Number	:	210-673-3616

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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