Healthcare Provider Details

I. General information

NPI: 1245120468
Provider Name (Legal Business Name): QUANG NGUYEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ROGERS RD
IRVING TX
75060-2608
US

IV. Provider business mailing address

4320 GIOVANNI DR
PLANO TX
75024-7319
US

V. Phone/Fax

Practice location:
  • Phone: 972-213-0045
  • Fax:
Mailing address:
  • Phone: 714-251-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41686
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: