Provider Demographics
NPI:1639282130
Name:NGUYEN, TRUONG
Entity Type:Individual
Prefix:
First Name:TRUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-6103
Mailing Address - Country:US
Mailing Address - Phone:484-392-7687
Mailing Address - Fax:484-392-7688
Practice Address - Street 1:1570 EGYPT RD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:484-392-7687
Practice Address - Fax:484-392-7688
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice