Provider Demographics
NPI:1609851799
Name:THU T TRUONG DDS PC
Entity Type:Organization
Organization Name:THU T TRUONG DDS PC
Other - Org Name:NEWMAN GROVE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THU
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:THUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-447-6469
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:412 HALE AVE
Mailing Address - City:NEWMAN GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68758
Mailing Address - Country:US
Mailing Address - Phone:402-447-6469
Mailing Address - Fax:402-447-6098
Practice Address - Street 1:412 HALE AVE
Practice Address - Street 2:
Practice Address - City:NEWMAN GROVE
Practice Address - State:NE
Practice Address - Zip Code:68758
Practice Address - Country:US
Practice Address - Phone:402-447-6469
Practice Address - Fax:402-447-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5593122300000X
SDM900122300000X
CA37614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========01Medicaid