# GREAT PLAINS RADIOLOGY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104558915
- **Authorized official:** DUSTIN D NGUYEN DO (OWNER)
- **Authorized official phone:** (817) 881-2765

## Contact information

- **Practice address:** 4381 NW WATER LILY PL, CAMAS, WA 98607-8843
- **Practice address phone:** (817) 881-2765
- **Practice address fax:** (817) 259-2759
- **Mailing address:** 4381 NW WATER LILY PL, CAMAS, WA 98607-8843
- **Mailing address phone:** (817) 881-2765
- **Mailing address fax:** (817) 259-2759

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/29/2022
- **Last updated:** 01/27/2023