Provider Demographics
NPI:1588813802
Name:TRUONG, MING YING (DDS)
Entity Type:Individual
Prefix:
First Name:MING
Middle Name:YING
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 S BROADWAY AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5274
Mailing Address - Country:US
Mailing Address - Phone:903-581-2198
Mailing Address - Fax:903-581-9571
Practice Address - Street 1:7916 S BROADWAY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5274
Practice Address - Country:US
Practice Address - Phone:903-581-2198
Practice Address - Fax:903-581-9571
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243911223G0001X
CA57645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198285207Medicaid
TX198285208Medicaid