MEDICARE: NGUYEN FAMILY DENTAL, PA

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	122300000X	Dentist	19859	TX

General Provider Information

NPI Number	:	1922003557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NGUYEN FAMILY DENTAL, PA

Provider Business Mailing Address
First Line	:	12804 GULF FWY
Second Line	:	STE 400
City	:	HOUSTON
State	:	TX
Zip	:	77034-4813
Country	:	US
Telephone Number	:	281-481-2048
Fax Number	:	281-484-4193

Provider Business Practice Location Address
First Line	:	12804 GULF FWY
Second Line	:	STE 400
City	:	HOUSTON
State	:	TX
Zip	:	77034-4813
Country	:	US
Telephone Number	:	281-481-2048
Fax Number	:	281-484-4193

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KHANH DUY NGUYEN
Credential	:	DDS
Telephone Number	:	281-481-2048

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/22/2020

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