Provider Demographics
NPI:1093961534
Name:TRUONG, MANH CHI (DMD)
Entity Type:Individual
Prefix:
First Name:MANH
Middle Name:CHI
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 DOROTHY AVE. APT 5
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:408-390-1384
Mailing Address - Fax:
Practice Address - Street 1:4410 SE 82ND AVE UNIT 2050
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2955
Practice Address - Country:US
Practice Address - Phone:503-771-0081
Practice Address - Fax:503-772-2272
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist