Provider Demographics
NPI:1073733697
Name:QUYNH TRAM T TRUONG DDS INC
Entity Type:Organization
Organization Name:QUYNH TRAM T TRUONG DDS INC
Other - Org Name:123 SMILE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYNH-TRAM
Authorized Official - Middle Name:THI
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-542-7400
Mailing Address - Street 1:1641 E 17TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8535
Mailing Address - Country:US
Mailing Address - Phone:714-542-7400
Mailing Address - Fax:714-543-3536
Practice Address - Street 1:1641 E 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8535
Practice Address - Country:US
Practice Address - Phone:714-542-7400
Practice Address - Fax:714-543-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93018OtherDENTI-CAL ID NUMBER