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General NPI Number Information
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NPI Number | 1649455288
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Entity Type | Organization
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Legal Business Name | CY-FAIR DENTAL CARE
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 11811 FM 1960 RD W SUITE #185
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City | HOUSTON
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State | TX
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Zip | 77065-3827
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Country | US
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Telephone | 281-970-2277
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Fax | 281-970-2960
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Provider Business Mailing Address
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Address Line | 11811 FM 1960 RD W SUITE #185
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City | HOUSTON
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State | TX
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Zip | 77065-3827
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Country | US
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Telephone | 281-970-2277
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Fax | 281-970-2960
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Authorized Official
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Title or Position | OWNER-DENTIST
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Name | DR. MICHAEL MOO NGUYEN
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Credential | D.D.S.
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Telephone | 281-970-2277
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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 | 19429
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License Number State | TX
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