Individual provider Active NPI

Kristina Nguyen

  • General Practice Dentistry
  • Longview, TX
National Provider Identifier
1851080949
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
39641 Issued in TX
Practice address
1107 E Marshall Ave
Longview, TX 75601-5602
Phone
(903) 758-2610
Fax
(903) 758-7081
NPI assigned
May 3, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 39641 TX Primary

Addresses

Primary practice location

1107 E Marshall Ave
Longview, TX 75601-5602

Mailing address

1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 758-2610

Other practice location 1

1800 DeSoto Ct
Allen, TX 75002-7582
Phone (972) 978-0009

Other practice location 2

602 Titus St Ste 130
Gilmer, TX 75644-1780
Phone (903) 758-2610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240621003824 TX Practitioner - Dentist 4981147659 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39641TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Longview Wellness Center, Inc General Practice Current Accepting new patients
Longview Wellness Center Inc CurrentSince Jul 18, 2024 Accepting new patients
Longview Wellness Center, Inc. CurrentSince Jul 18, 2024 Accepting new patients
Longview Wellness Center Inc PastSince Jan 2, 2022 Accepting new patients

Locations

602 Titus St
Ste 130
Gilmer, TX 75644

1701 Pine Tree Rd
Longview, TX 75604
Phone (903) 295-5151

1107 E Marshall Ave
Longview, TX 75601
Phone (903) 212-4763

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1851080949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015602",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015602",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 DeSoto Ct",
            "address_purpose": "LOCATION",
            "city": "Allen",
            "state": "TX",
            "postal_code": "750027582",
            "country_code": "US",
            "telephone_number": "972-978-0009",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "602 Titus St Ste 130",
            "address_purpose": "LOCATION",
            "city": "Gilmer",
            "state": "TX",
            "postal_code": "756441780",
            "country_code": "US",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KRISTINA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-03",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.