Provider Demographics
NPI:1093268161
Name:KURT TRUONG, DDS, MSD, PLLC
Entity Type:Organization
Organization Name:KURT TRUONG, DDS, MSD, PLLC
Other - Org Name:PLEASANT VALLEY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:360-573-3176
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 3102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-573-3176
Mailing Address - Fax:360-571-3276
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 3102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-573-3176
Practice Address - Fax:360-571-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60299879261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049798Medicaid