Provider Demographics
NPI:1194085209
Name:NGUYEN, SON NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:SON
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DULLES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4727
Mailing Address - Country:US
Mailing Address - Phone:281-886-9611
Mailing Address - Fax:
Practice Address - Street 1:203 DULLES AVE STE 300
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4727
Practice Address - Country:US
Practice Address - Phone:281-886-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics