MEDICARE: EMERALD FAMILY DENTISTRY PLLC

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

General Provider Information

NPI Number	:	1952745630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD FAMILY DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	5705 FONDREN RD STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1843
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	:	281-853-4963
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. QUYNH LAN NGUYEN
Credential	:	DMD
Telephone Number	:	281-853-4963

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	05/28/2021

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