Provider Demographics
NPI:1497304844
Name:TRUONG, NICK HOANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:HOANG
Last Name:TRUONG
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 1:1201 N GARFIELD ST APT 505
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6811
Mailing Address - Country:US
Mailing Address - Phone:703-554-4083
Mailing Address - Fax:
Practice Address - Street 1:1050 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-4428
Practice Address - Country:US
Practice Address - Phone:703-527-3888
Practice Address - Fax:703-527-6888
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17107122300000X
VA0401416737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty