MEDICARE: JIMMY U. 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	29011	TX

General Provider Information

NPI Number	:	1700226651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY U. NGUYEN DDS

Provider Business Mailing Address
First Line	:	610 N WILLOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-6314
Country	:	US
Telephone Number	:	504-491-5363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 W BAILEY BOSWELL RD STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4327
Country	:	US
Telephone Number	:	682-250-2080
Fax Number	:

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	02/28/2020

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