Provider Demographics
NPI:1386856995
Name:TRUONG DENTAL CORPORATION
Entity Type:Organization
Organization Name:TRUONG DENTAL CORPORATION
Other - Org Name:UNITED DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-373-4855
Mailing Address - Street 1:1523 N VASCO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9035
Mailing Address - Country:US
Mailing Address - Phone:925-373-4855
Mailing Address - Fax:925-373-2855
Practice Address - Street 1:1523 N VASCO RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9035
Practice Address - Country:US
Practice Address - Phone:925-373-4855
Practice Address - Fax:925-373-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44635261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental