Provider Demographics
NPI:1164543211
Name:TRUONG, DIEP
Entity Type:Individual
Prefix:
First Name:DIEP
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5525
Mailing Address - Country:US
Mailing Address - Phone:214-893-6109
Mailing Address - Fax:
Practice Address - Street 1:1050 N WESTMORELAND RD
Practice Address - Street 2:SUITE 432B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-337-7800
Practice Address - Fax:214-337-7802
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158135708Medicaid