Provider Demographics
NPI:1063513299
Name:NGUYEN, TAM M (DDS)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 DOUBLE CREEK DR
Mailing Address - Street 2:#2001
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3836
Mailing Address - Country:US
Mailing Address - Phone:512-310-0330
Mailing Address - Fax:512-310-0901
Practice Address - Street 1:2201 DOUBLE CREEK DR
Practice Address - Street 2:#2001
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3836
Practice Address - Country:US
Practice Address - Phone:512-310-0330
Practice Address - Fax:512-310-0901
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice