Provider Demographics
NPI:1609283100
Name:TRUONG, TUAN H (DMD)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:H
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 SW WASHOUGA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1375
Mailing Address - Country:US
Mailing Address - Phone:503-381-3980
Mailing Address - Fax:
Practice Address - Street 1:4210 SW WASHOUGA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1375
Practice Address - Country:US
Practice Address - Phone:503-381-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist