Provider Demographics
NPI:1629371281
Name:DUONG, TRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAM
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLEASANT ST
Mailing Address - Street 2:APT 703
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1455
Mailing Address - Country:US
Mailing Address - Phone:310-482-9519
Mailing Address - Fax:
Practice Address - Street 1:2800 LYELL SPENCERPORT RD # A
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1977
Practice Address - Country:US
Practice Address - Phone:585-352-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0552551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry