Provider Demographics
NPI:1124561659
Name:JESSICA T TRUONG DDS & DANNY T TRUONG DDS, INC
Entity Type:Organization
Organization Name:JESSICA T TRUONG DDS & DANNY T TRUONG DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-972-1046
Mailing Address - Street 1:9878 HIBERT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1020
Mailing Address - Country:US
Mailing Address - Phone:858-779-3111
Mailing Address - Fax:
Practice Address - Street 1:9878 HIBERT ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1020
Practice Address - Country:US
Practice Address - Phone:858-779-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty