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General NPI Number Information
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NPI Number | 1104117241
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Entity Type | Organization
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Legal Business Name | DAISY DENTAL P.C.
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Dates
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Enumeration Date | 04/24/2011
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Last Update Date | 07/16/2011
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Provider Practice Location Address
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Address Line | 3970 FM 2181 SUITE 200
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City | HICKORY CREEK
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State | TX
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Zip | 75065-4249
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Country | US
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Telephone | 972-999-3580
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Fax |
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Provider Business Mailing Address
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Address Line | 3970 FM 2181 SUITE 200
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City | HICKORY CREEK
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State | TX
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Zip | 75065-4249
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Country | US
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Telephone | 940-497-6453
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. JOHNIE M NGUYEN
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Credential | DDS
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Telephone | 940-497-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22585
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License Number State | TX
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