Organization
DAISY DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNIE M NGUYEN DDS (DENTIST/PRESIDENT)
(940) 497-6453
Entity
Organization
Contact information
Practice address
3970 FM 2181, SUITE 200, HICKORY CREEK, TX 75065-4249
(972) 999-3580
Mailing address
3970 FM 2181, SUITE 200, HICKORY CREEK, TX 75065-4249
(940) 497-6453
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22585
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1900193-03
MEDICAID PROVIDER
TX
05
—
2208027-01
—
TX
Enumeration date
04/24/2011
Last updated
07/16/2011
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