Provider Demographics
NPI:1295029163
Name:TRUONG, VICTOR DUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DUC
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 CENTER ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1446
Mailing Address - Country:US
Mailing Address - Phone:925-219-3939
Mailing Address - Fax:925-270-0615
Practice Address - Street 1:6200 CENTER ST
Practice Address - Street 2:SUITE I
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1446
Practice Address - Country:US
Practice Address - Phone:925-219-3939
Practice Address - Fax:925-270-0615
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice