MEDICARE: VAN THANH 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	59773	CA
2	1223G0001X	General Practice Dentistry	26359	TX

General Provider Information

NPI Number	:	1518262054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAN THANH NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	2171 BUCKINGHAM RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5484
Country	:	US
Telephone Number	:	972-235-3999
Fax Number	:	469-640-2623

Provider Business Practice Location Address
First Line	:	2171 BUCKINGHAM RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5484
Country	:	US
Telephone Number	:	972-235-3999
Fax Number	:	469-640-2623

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

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	10/24/2019

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