Provider Demographics
NPI:1023688421
Name:NGUYEN, BOIDIEP VU (DMD)
Entity type:Individual
Prefix:
First Name:BOIDIEP
Middle Name:VU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 BELLAIRE BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1721
Mailing Address - Country:US
Mailing Address - Phone:281-818-4604
Mailing Address - Fax:
Practice Address - Street 1:11828 BELLAIRE BLVD
Practice Address - Street 2:STE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1721
Practice Address - Country:US
Practice Address - Phone:281-818-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice