Provider Demographics
NPI:1891510152
Name:WYNN DENTAL PLLC
Entity type:Organization
Organization Name:WYNN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-535-4874
Mailing Address - Street 1:8870 COIT RD STE 112
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6346
Mailing Address - Country:US
Mailing Address - Phone:469-777-8990
Mailing Address - Fax:469-777-8893
Practice Address - Street 1:8870 COIT RD STE 112
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6346
Practice Address - Country:US
Practice Address - Phone:469-777-8990
Practice Address - Fax:469-777-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty