MEDICARE: THOMAS 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	DE00010624	WA
2	122300000X	Dentist	25414	TX

General Provider Information

NPI Number	:	1558420455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS NGUYEN D.D.S

Provider Business Mailing Address
First Line	:	3114 PARIS DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-3568
Country	:	US
Telephone Number	:	206-948-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 S PADRE ISLAND DR
Second Line	:	SUITE #250
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1353
Country	:	US
Telephone Number	:	206-948-3741
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/06/2017

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