Provider Demographics
NPI:1598822769
Name:DR. QUYNH TRAM T. TRUONG, DDS, INC
Entity Type:Organization
Organization Name:DR. QUYNH TRAM T. TRUONG, DDS, INC
Other - Org Name:123 SMILE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:QUYNH
Authorized Official - Middle Name:TRAM
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-360-0000
Mailing Address - Street 1:6000 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5362
Mailing Address - Country:US
Mailing Address - Phone:951-360-0000
Mailing Address - Fax:951-616-2036
Practice Address - Street 1:6000 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5362
Practice Address - Country:US
Practice Address - Phone:951-360-0000
Practice Address - Fax:951-616-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93018Medicare ID - Type UnspecifiedDENTICAL PROVIDER NUMBER