Provider Demographics
NPI:1285786723
Name:NGUYEN, KHANH DUY (DDS)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:DUY
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 1:12804 GULF FWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4813
Mailing Address - Country:US
Mailing Address - Phone:281-481-2048
Mailing Address - Fax:281-484-4193
Practice Address - Street 1:12804 GULF FWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4813
Practice Address - Country:US
Practice Address - Phone:281-481-2048
Practice Address - Fax:281-484-4193
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice