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General NPI Number Information
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NPI Number | 1962070300
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Entity Type | Individual
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Provider Name | THUONG HUYNH DDS, MDS, CDT, FACP
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Gender | Male
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Dates
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Enumeration Date | 06/13/2021
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 795 RIDGE LAKE BLVD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38120-9475
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Country | US
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Telephone | 901-682-5001
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Fax | 901-682-5099
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Provider Business Mailing Address
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Address Line | 795 RIDGE LAKE BLVD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38120-9475
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Country | US
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Telephone | 901-682-5001
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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 | 4259-21
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 11605
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License Number State | TN
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