Provider Demographics
NPI:1508025719
Name:DO, CHUONG (DDS)
Entity Type:Individual
Prefix:
First Name:CHUONG
Middle Name:
Last Name:DO
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 1:6861 SEACOAST DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6828
Mailing Address - Country:US
Mailing Address - Phone:871-966-0648
Mailing Address - Fax:
Practice Address - Street 1:1735 N STORY RD STE 180
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-1951
Practice Address - Country:US
Practice Address - Phone:871-966-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice