Provider Demographics
NPI:1689687105
Name:TRUONG, TU-DINH (DDS)
Entity Type:Individual
Prefix:
First Name:TU-DINH
Middle Name:
Last Name:TRUONG
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 1:40101 MONTEREY AVE
Mailing Address - Street 2:SUITE #G4
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3261
Mailing Address - Country:US
Mailing Address - Phone:760-776-5488
Mailing Address - Fax:760-776-5483
Practice Address - Street 1:40101 MONTEREY AVE
Practice Address - Street 2:SUITE #G4
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3261
Practice Address - Country:US
Practice Address - Phone:760-776-5488
Practice Address - Fax:760-776-5483
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice