Provider Demographics
NPI:1528121332
Name:NGUYEN, DAN (DMD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 BABCOCK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2980
Mailing Address - Country:US
Mailing Address - Phone:210-696-8050
Mailing Address - Fax:
Practice Address - Street 1:6415 BABCOCK RD STE 105
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2963
Practice Address - Country:US
Practice Address - Phone:210-696-8050
Practice Address - Fax:210-696-2018
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17776122300000X
TX25084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist