Individual
DR. KEVIN PHUONG MINH NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1665 W TEVAS AVE, WASKOM, TX 75692-6496
(903) 686-1667
Mailing address
3147 S CAMINO LAGOS, GRAND PRAIRIE, TX 75054-6496
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22458
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179255801
—
TX
01
—
B22458-01
TX CHIP
TX
Enumeration date
09/07/2006
Last updated
12/09/2024
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