Provider Demographics
NPI:1538274246
Name:MARTIN, TRACY NGUYEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NGUYEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-7104
Mailing Address - Country:US
Mailing Address - Phone:832-640-0346
Mailing Address - Fax:
Practice Address - Street 1:5800 BELLAIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5537
Practice Address - Country:US
Practice Address - Phone:713-667-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice