MEDICARE: LYNN MY 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	6299	OK

General Provider Information

NPI Number	:	1700314317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN MY NGUYEN DDS

Provider Business Mailing Address
First Line	:	2220 SW 33RD ST
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73170-4542
Country	:	US
Telephone Number	:	505-204-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 NW EXPRESSWAY STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7207
Country	:	US
Telephone Number	:	405-943-0123
Fax Number	:

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

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	03/17/2018

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