Provider Demographics
NPI:1285704395
Name:LAN M NGUYEN
Entity type:Organization
Organization Name:LAN M NGUYEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-461-5510
Mailing Address - Street 1:2235 CARTER DR #109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010
Mailing Address - Country:US
Mailing Address - Phone:817-461-5510
Mailing Address - Fax:817-460-5448
Practice Address - Street 1:2235 CARTER DR #109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010
Practice Address - Country:US
Practice Address - Phone:817-461-5510
Practice Address - Fax:817-460-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty