Provider Demographics
NPI:1982424677
Name:MTN DENTAL GROUP CORPORATION
Entity type:Organization
Organization Name:MTN DENTAL GROUP CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIET
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-983-6199
Mailing Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6050
Mailing Address - Country:US
Mailing Address - Phone:817-583-6097
Mailing Address - Fax:817-583-6348
Practice Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6050
Practice Address - Country:US
Practice Address - Phone:817-583-6097
Practice Address - Fax:817-583-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty