Provider Demographics
NPI:1215484241
Name:NGUYEN, LIEM (DMD)
Entity type:Individual
Prefix:DR
First Name:LIEM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 SYCAMORE SCHOOL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-3051
Mailing Address - Country:US
Mailing Address - Phone:817-900-9115
Mailing Address - Fax:682-282-3222
Practice Address - Street 1:5228 SYCAMORE SCHOOL RD STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-3051
Practice Address - Country:US
Practice Address - Phone:179-009-1158
Practice Address - Fax:682-282-3222
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32172122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist