Healthcare Provider Details

I. General information

NPI: 1821787870
Provider Name (Legal Business Name): TONY N NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3315
US

IV. Provider business mailing address

2346 LUCAS DR
DALLAS TX
75219-1734
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-3042
  • Fax:
Mailing address:
  • Phone: 469-531-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026022792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: