Provider Demographics
NPI:1306225206
Name:DOAN, MATTHEW TUAN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TUAN
Last Name:DOAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 HELMS TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7058
Mailing Address - Country:US
Mailing Address - Phone:214-537-7531
Mailing Address - Fax:
Practice Address - Street 1:2150 N JOSEY LN
Practice Address - Street 2:#306
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2991
Practice Address - Country:US
Practice Address - Phone:972-820-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611662891223G0001X
GADN1225701223G0001X
TN115681223G0001X
SC101111223G0001X
GAD0114651223G0001X
NC125261223G0001X
CODEN.002050461223G0001X
FLDN247941223G0001X
TX309991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice