Provider Demographics
NPI:1194982991
Name:NGUYEN, MINHLY DUY (DDS)
Entity type:Individual
Prefix:DR
First Name:MINHLY
Middle Name:DUY
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 1:12125 HIGHWAY 6 STE D
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8844
Mailing Address - Country:US
Mailing Address - Phone:281-431-8909
Mailing Address - Fax:281-431-8985
Practice Address - Street 1:12125 HIGHWAY 6 STE D
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8844
Practice Address - Country:US
Practice Address - Phone:281-431-8909
Practice Address - Fax:281-431-8985
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214851223G0001X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161994211Medicaid