Provider Demographics
NPI:1053745927
Name:NGUYEN, THIEN VAN (DDS)
Entity type:Individual
Prefix:
First Name:THIEN
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 W PIONEER PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3602
Mailing Address - Country:US
Mailing Address - Phone:972-352-2980
Mailing Address - Fax:972-352-2990
Practice Address - Street 1:2615 W PIONEER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3602
Practice Address - Country:US
Practice Address - Phone:714-352-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296901223G0001X
NY50 056913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist