MEDICARE: JOHN T NGUYEN DDS PA

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	21724	TX

General Provider Information

NPI Number	:	1508001306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN T NGUYEN DDS PA

Provider Business Mailing Address
First Line	:	7014 PETTIGREW DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4855
Country	:	US
Telephone Number	:	713-972-4455
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN NGUYEN
Credential	:	DDS
Telephone Number	:	713-972-4455

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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