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General NPI Number Information
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NPI Number | 1982424677
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Entity Type | Organization
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Legal Business Name | MTN DENTAL GROUP CORPORATION
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3901 ARLINGTON HIGHLANDS BLVD STE 200
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City | ARLINGTON
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State | TX
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Zip | 76018-6050
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Country | US
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Telephone | 817-583-6097
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Fax | 817-583-6348
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Provider Business Mailing Address
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Address Line | 3901 ARLINGTON HIGHLANDS BLVD STE 200
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City | ARLINGTON
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State | TX
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Zip | 76018-6050
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Country | US
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Telephone | 817-583-6097
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Fax | 817-583-6348
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Authorized Official
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Title or Position | DOCTOR
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Name | KIET D NGUYEN
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Credential | DDS
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Telephone | 817-983-6199
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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 |
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License Number State |
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