Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 21120 | TX |
NPI | 1063719953 |
---|---|
Provider Name | Dr. Tien Nguyen |
First Address | Dallas, TX 75214-3132 |
Second Address | Mesquite, TX 75150-5713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2011 |
Last Update Date | 14/02/2011 |