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General NPI Number Information
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NPI Number | 1295992675
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Entity Type | Individual
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Provider Name | SY DAN NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 2815 AZLE AVE
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City | FORT WORTH
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State | TX
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Zip | 76106-5106
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Country | US
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Telephone | 817-624-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 N GRAPEVINE MILLS BLVD APT 2225
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City | GRAPEVINE
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State | TX
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Zip | 76051-0971
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Country | US
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Telephone | 614-209-6859
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 26293
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License Number State | TX
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