Provider Demographics
NPI:1093360604
Name:NGUYEN, JOE TRUONG (DDS, PHD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:TRUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 POOKS HILL RD APT 515
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5412
Mailing Address - Country:US
Mailing Address - Phone:408-444-3621
Mailing Address - Fax:
Practice Address - Street 1:176 THOMAS JOHNSON DR STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4532
Practice Address - Country:US
Practice Address - Phone:301-663-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice