Provider Demographics
NPI:1215181110
Name:TRUONG, THANH THI (RDH, BS)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2542
Mailing Address - Country:US
Mailing Address - Phone:503-888-0257
Mailing Address - Fax:503-284-1419
Practice Address - Street 1:5325 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2542
Practice Address - Country:US
Practice Address - Phone:503-888-0257
Practice Address - Fax:503-284-1419
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5510124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist