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General NPI Number Information
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NPI Number | 1205287281
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Entity Type | Organization
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Legal Business Name | MESQUITE FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 2758 N GALLOWAY AVE #300
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City | MESQUITE
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State | TX
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Zip | 75150-6380
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Country | US
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Telephone | 972-289-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 2758 N GALLOWAY AVE #300
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City | MESQUITE
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State | TX
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Zip | 75150-6380
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Country | US
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Telephone | 972-289-5563
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TUAN NGUYEN
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Credential | DDS
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Telephone | 972-289-5563
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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 | 21736
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License Number State | TX
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