Provider Demographics
NPI:1962070300
Name:HUYNH, THUONG (DDS, MDS, CDT, FACP)
Entity type:Individual
Prefix:DR
First Name:THUONG
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DDS, MDS, CDT, FACP
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MDS, CDT, FACP
Mailing Address - Street 1:795 RIDGE LAKE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9475
Mailing Address - Country:US
Mailing Address - Phone:901-682-5001
Mailing Address - Fax:
Practice Address - Street 1:795 RIDGE LAKE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9475
Practice Address - Country:US
Practice Address - Phone:901-682-5001
Practice Address - Fax:901-682-5099
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4259-21122300000X
TN116051223P0700X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist