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General NPI Number Information
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NPI Number | 1962506345
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Entity Type | Individual
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Provider Name | KEVIN PHUONG MINH NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1665 W TEVAS AVE
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City | WASKOM
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State | TX
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Zip | 75692-6496
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Country | US
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Telephone | 903-686-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 3147 S CAMINO LAGOS
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-6496
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Country | US
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Telephone |
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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 | 22458
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License Number State | TX
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