Provider Demographics
NPI:1215600986
Name:NGUYEN, TRUNG THE
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:THE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TRUNG
Other - Middle Name:THE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3700 MARKET ST STE A2
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2652
Mailing Address - Country:US
Mailing Address - Phone:404-296-8877
Mailing Address - Fax:
Practice Address - Street 1:3700 MARKET ST STE A2
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2652
Practice Address - Country:US
Practice Address - Phone:404-296-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice