Provider Demographics
NPI:1598062119
Name:KEVIN TRUONG, DMD PLLC
Entity Type:Organization
Organization Name:KEVIN TRUONG, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-325-4227
Mailing Address - Street 1:2603 W WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1582
Mailing Address - Country:US
Mailing Address - Phone:509-325-4227
Mailing Address - Fax:509-326-1043
Practice Address - Street 1:2603 W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1582
Practice Address - Country:US
Practice Address - Phone:509-325-4227
Practice Address - Fax:509-326-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600990001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty