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General NPI Number Information
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NPI Number | 1083876239
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Entity Type | Individual
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Provider Name | DAVID PHONG NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 07/19/2009
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Provider Practice Location Address
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Address Line | 10505 CHURCH RD
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City | DALLAS
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State | TX
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Zip | 75238-2224
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Country | US
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Telephone | 214-341-3114
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 BLACKBURN LN
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City | PLANO
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State | TX
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Zip | 75025-3420
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Country | US
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Telephone | 817-881-7435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23998
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License Number State | TX
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