Provider Demographics
NPI:1033613567
Name:TRUONG, TRACY NHU (DMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NHU
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 1:23320 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8744
Mailing Address - Country:US
Mailing Address - Phone:425-640-5533
Mailing Address - Fax:425-640-5534
Practice Address - Street 1:23320 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8744
Practice Address - Country:US
Practice Address - Phone:425-640-5533
Practice Address - Fax:425-640-5534
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR60855806122300000X
390200000X
WADE60954009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program