Provider Demographics
NPI:1558814368
Name:VICTOR TRUONG, DDS, DENTAL CORP
Entity Type:Organization
Organization Name:VICTOR TRUONG, DDS, DENTAL CORP
Other - Org Name:THE GROVE FAMILY DENTISTRY DENTAL PRACTICE OF DR. VICTOR TRUONG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-330-5157
Mailing Address - Street 1:6200 CENTER ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1446
Mailing Address - Country:US
Mailing Address - Phone:925-330-5157
Mailing Address - Fax:
Practice Address - Street 1:6200 CENTER ST
Practice Address - Street 2:SUITE I
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1446
Practice Address - Country:US
Practice Address - Phone:925-330-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59878261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental