Provider Demographics
NPI:1033217732
Name:TRUONG, TINA NGA (DMD)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:NGA
Last Name:TRUONG
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 1:4810 BEAUREGARD ST
Mailing Address - Street 2:#200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312
Mailing Address - Country:US
Mailing Address - Phone:703-333-5105
Mailing Address - Fax:703-333-5106
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:#200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312
Practice Address - Country:US
Practice Address - Phone:703-333-5105
Practice Address - Fax:703-333-5106
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist