Healthcare Provider Details

I. General information

NPI: 1215256722
Provider Name (Legal Business Name): AGUA DENTAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 W MILLER RD
GARLAND TX
75041-1811
US

IV. Provider business mailing address

843 W MILLER RD
GARLAND TX
75041-1811
US

V. Phone/Fax

Practice location:
  • Phone: 972-864-0222
  • Fax: 972-864-0200
Mailing address:
  • Phone: 972-864-0222
  • Fax: 972-864-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21686
License Number StateTX

VIII. Authorized Official

Name: DR. NHUT NGOC NGUYEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 469-867-3553