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NPI Code Detail

MEDICARE: DR. SY DAN NGUYEN DDS

MEDICARE: DR. SY DAN NGUYEN DDS
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
1122300000XDentist26293TX

General Provider Information

NPI Number : 1295992675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SY DAN NGUYEN DDS
Provider Business Mailing Address
First Line : 3225 N GRAPEVINE MILLS BLVD
Second Line : APT 2225
City : GRAPEVINE
State : TX
Zip : 76051-0971
Country : US
Telephone Number : 614-209-6859
Fax Number :
Provider Business Practice Location Address
First Line : 2815 AZLE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76106-5106
Country : US
Telephone Number : 817-624-0222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 09/30/2011

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