MEDICARE: DR. CASSANDRA 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
1	1223G0001X	General Practice Dentistry	39508	TX

General Provider Information

NPI Number	:	1689366833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSANDRA NGUYEN DDS

Provider Business Mailing Address
First Line	:	2727 REVERE ST APT 3008
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1377
Country	:	US
Telephone Number	:	913-709-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4808
Country	:	US
Telephone Number	:	972-444-8888
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/14/2023

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