Provider Demographics
NPI:1114257672
Name:TRUONG, TIN T (DD,S,)
Entity Type:Individual
Prefix:
First Name:TIN
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DD,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 GARTH RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2123
Mailing Address - Country:US
Mailing Address - Phone:281-422-0123
Mailing Address - Fax:281-837-7371
Practice Address - Street 1:4567 GARTH RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2123
Practice Address - Country:US
Practice Address - Phone:281-422-0123
Practice Address - Fax:281-837-7371
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD79201223G0001X
TX253411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice