Provider Demographics
NPI:1508567512
Name:TRUONG, DIEU T (DH 61310555)
Entity Type:Individual
Prefix:
First Name:DIEU
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DH 61310555
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N COACH DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5149
Mailing Address - Country:US
Mailing Address - Phone:509-263-5492
Mailing Address - Fax:
Practice Address - Street 1:21801 E COUNTRY VISTA DR STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7727
Practice Address - Country:US
Practice Address - Phone:509-926-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61310555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist