MEDICARE: MONIKA TU-KHANH NGUYEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	23627	TX

General Provider Information

NPI Number	:	1063691202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIKA TU-KHANH NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	10763 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3806
Country	:	US
Telephone Number	:	214-217-4411
Fax Number	:	214-217-4412

Provider Business Practice Location Address
First Line	:	10763 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3806
Country	:	US
Telephone Number	:	214-217-4411
Fax Number	:	214-217-4412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	07/24/2012

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