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General NPI Number Information
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NPI Number | 1497285993
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Entity Type | Individual
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Provider Name | THI KIM LY NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 7075 W WHEATLAND RD
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City | DALLAS
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State | TX
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Zip | 75249-1067
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Country | US
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Telephone | 972-905-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 VILLAGE GRN
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City | RICHARDSON
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State | TX
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Zip | 75081-5479
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Country | US
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Telephone | 469-531-9479
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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 | 32937
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License Number State | TX
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