Provider Demographics
NPI:1427433747
Name:NGUYEN, BEN VAN
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:VAN
Last Name:NGUYEN
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 1:3101 DENTON HWY SUITE #100
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117
Mailing Address - Country:US
Mailing Address - Phone:817-831-6500
Mailing Address - Fax:817-831-0775
Practice Address - Street 1:3101 DENTON HWY SUITE #100
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117
Practice Address - Country:US
Practice Address - Phone:817-831-6500
Practice Address - Fax:817-831-0775
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31205122300000X
CA64605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist