=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023305422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS NGUYEN DINH DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 07/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 NE ALSBURY BLVD SUITE 600
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-500-9135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2429 LIMESTONE DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-919-0791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 27141
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------