Basic Information
| Provider Information | |||||||||
| NPI: | 1033778212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYENDAC | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | LE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4071 LEE RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441282173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167270234 | ||||||||
| FaxNumber: | 4403818800 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG. 4250 CLEAR CREEK ROAD | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542852014 | ||||||||
| FaxNumber: | 2542852182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | RES.004093 | OH | N | Dental Providers | Dentist | 122300000X | 36128 | TX | Y | Dental Providers | Dentist |
No ID Information.