Provider Demographics
NPI:1083332399
Name:TRUONG, MICHELE THUC-HA
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:THUC-HA
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 MINA WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2110
Mailing Address - Country:US
Mailing Address - Phone:832-353-0103
Mailing Address - Fax:
Practice Address - Street 1:4125 RICHMOND PKWY STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2508
Practice Address - Country:US
Practice Address - Phone:281-560-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist