Healthcare Provider Details

I. General information

NPI: 1063719953
Provider Name (Legal Business Name): TIEN NGUYEN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 N GALLOWAY AVE SUITE 120
MESQUITE TX
75150-5713
US

IV. Provider business mailing address

6815 MERRILEE LN
DALLAS TX
75214-3132
US

V. Phone/Fax

Practice location:
  • Phone: 972-216-0300
  • Fax: 972-216-0700
Mailing address:
  • Phone: 214-564-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: