Provider Demographics
NPI:1548549751
Name:NGUYEN, THANH-XUAN B (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH-XUAN
Middle Name:B
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:XUAN
Other - Middle Name:B
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:401 EVENTIDE WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8201
Mailing Address - Country:US
Mailing Address - Phone:504-615-2205
Mailing Address - Fax:
Practice Address - Street 1:4400 HERITAGE TRACE PWKY
Practice Address - Street 2:STE #212
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76034-4510
Practice Address - Country:US
Practice Address - Phone:817-482-1400
Practice Address - Fax:817-482-1401
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice