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General NPI Number Information
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NPI Number | 1922431519
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Entity Type | Organization
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Legal Business Name | MTK DENTISTRY, PLLC
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 09/29/2013
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Provider Practice Location Address
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Address Line | 743 BRICK ROW DR STE 220
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City | RICHARDSON
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State | TX
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Zip | 75081-4947
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Country | US
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Telephone | 214-502-5128
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Fax |
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Provider Business Mailing Address
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Address Line | 4014 MUSTANG AVE
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City | SACHSE
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State | TX
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Zip | 75048-4270
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Country | US
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Telephone | 214-502-5128
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MINH TRUNG NGUYEN
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Credential | DMD
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Telephone | 214-502-5128
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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 | 24000
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License Number State | TX
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