Provider Demographics
NPI:1619676384
Name:TAM S TRUONG A PROFESSIONAL DENTAL HYGIENE CORP.
Entity Type:Organization
Organization Name:TAM S TRUONG A PROFESSIONAL DENTAL HYGIENE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIC WITH ADVANCE PRACTI
Authorized Official - Prefix:
Authorized Official - First Name:TAM
Authorized Official - Middle Name:SY
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:949-646-4300
Mailing Address - Street 1:1419 SUPERIOR AVE #6
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-646-4300
Mailing Address - Fax:
Practice Address - Street 1:1419 SUPERIOR AVE #6
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-646-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty