Provider Demographics
NPI:1538365630
Name:NGUYEN, MARIA LINH (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINH
Other - Middle Name:MY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10264 RED BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7352
Mailing Address - Country:US
Mailing Address - Phone:954-608-9984
Mailing Address - Fax:
Practice Address - Street 1:12227 LAKE JUNE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-1633
Practice Address - Country:US
Practice Address - Phone:972-216-8880
Practice Address - Fax:972-216-8882
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice