MEDICARE: DR. TRACY NGUYEN MARTIN 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	22856	TX

General Provider Information

NPI Number	:	1538274246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY NGUYEN MARTIN D.D.S.

Provider Business Mailing Address
First Line	:	702 E 10TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-7104
Country	:	US
Telephone Number	:	832-640-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 BELLAIRE BLVD STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5537
Country	:	US
Telephone Number	:	713-667-4077
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/28/2018

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