Provider Demographics
NPI:1063719953
Name:NGUYEN, TIEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TIEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 MERRILEE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3132
Mailing Address - Country:US
Mailing Address - Phone:214-564-7075
Mailing Address - Fax:
Practice Address - Street 1:2110 N GALLOWAY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5713
Practice Address - Country:US
Practice Address - Phone:972-216-0300
Practice Address - Fax:972-216-0700
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics