Selena Nguyen Ma, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37941 Issued in TX

Practice address

5800 N Tarrant Pkwy Ste 102
Fort Worth, TX 76244-8003

Phone

(817) 581-6453

NPI assigned

Jul 29, 2021

Last updated

Oct 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Selena Thao Nguyen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1770256398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 N GRAPEVINE MILLS BLVD APT 1222",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760510976",
            "telephone_number": "662-523-1178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 N TARRANT PKWY STE 102",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762448003",
            "telephone_number": "817-581-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "SELENA",
        "middle_name": "NGUYEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "37941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SELENA",
            "last_name": "NGUYEN",
            "middle_name": "THAO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.