MEDICARE: DR. TU KIM 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	24534	TX

General Provider Information

NPI Number	:	1295960599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TU KIM NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	5319 RIVER LAKE WAY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-0713
Country	:	US
Telephone Number	:	817-793-8102
Fax Number	:

Provider Business Practice Location Address
First Line	:	6302 MEADOWBROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5121
Country	:	US
Telephone Number	:	817-446-0800
Fax Number	:

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

Provider Enumeration Date	:	05/16/2009
Last Update Date	:	05/16/2009

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