Provider Demographics
NPI:1417928797
Name:MAI, TRUC TRUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRUC
Middle Name:TRUNG
Last Name:MAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 HIDDEN VALLEY PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860
Mailing Address - Country:US
Mailing Address - Phone:957-479-9410
Mailing Address - Fax:951-817-0649
Practice Address - Street 1:1161 HIDDEN VALLEY PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860
Practice Address - Country:US
Practice Address - Phone:957-479-9410
Practice Address - Fax:951-817-0649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist