Active NPI
Thanh Nam Nguyen, DDS
- Dentist
- Houston, TX
National Provider Identifier
1861554198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17532
- Practice address
- 11001 Fondren Road
Suite B
Houston, TX 77096 - Phone
- (713) 773-9800
- Fax
- (713) 773-9804
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17532 | TX | Primary |
Addresses
Primary practice location
11001 Fondren Road
Suite B
Houston, TX 77096
Mailing address
11001 Fondren Road
Suite B
Houston, TX 77096
Phone (713) 773-9800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891854154 | Medicaid | TX | |
| 1831258508 | Medicaid | TX | |
| 1861554198 | Medicaid | TX |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160303001168 | TX | Order and Referring Only - Oral Surgery | 4284930165 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17532 | TX | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adc Services : Dental P.C | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442966400000",
"number": "1861554198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11001 FONDREN ROAD",
"address_2": "SUITE B",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77096",
"telephone_number": "713-773-9800",
"fax_number": "713-773-9804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11001 FONDREN ROAD",
"address_2": "SUITE B",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77096",
"telephone_number": "713-773-9800",
"fax_number": "713-773-9804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "THANH",
"middle_name": "NAM",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2015-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "17532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891854154",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831258508",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861554198",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.