Individual
KELLY P NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5800 N TARRANT PKWY STE 102, FORT WORTH, TX 76244-8003
(817) 581-6453
Mailing address
3020 RIVERWOOD LN, GRAND PRAIRIE, TX 75052-0439
(817) 715-1248
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
38782
TX
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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