Provider Demographics
NPI:1598141079
Name:TRUONG, HAN HA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:HA
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HAN
Other - Middle Name:TRUONG
Other - Last Name:HAYSLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6509 TEXANA WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2089
Mailing Address - Country:US
Mailing Address - Phone:469-360-8854
Mailing Address - Fax:
Practice Address - Street 1:3809 S GENERAL BRUCE DR
Practice Address - Street 2:104
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1035
Practice Address - Country:US
Practice Address - Phone:254-778-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice